OBJECTIVES: To assess the methods used in the economic evaluation of robotic-assisted surgery (RAS) and investigate how they addressed the unique challenges of surgical innovation.

METHODS: We systematically searched PubMed, Ovid Medline, Embase and the Cochrane Library databases from 2015 to 2022. We included economic evaluations comparing RAS versus laparoscopic or open surgery. Data extraction followed Consolidated Health Economic Evaluation Reporting Standards (CHEERS) guidelines, focusing on study design, performed analyses, and main outcome measures. The unique challenges of surgical innovation, specifically issues relating to learning curve, incremental innovation, dynamic pricing, quality variation, and organizational impact, were recorded.

RESULTS: A total of 37 studies addressing the economic evaluation of RAS were included. Cost analyses (46%) described the costs of interventions and compared their resource utilization. Full economic evaluations (35%) assessed cost-effectiveness and explored the factors that drove cost-effectiveness. Cost consequence analyses (14%) included a range of outcomes such as complications, operating times and length of stay. Value analysis (5%) presented the value of RAS in a financial framework. Challenges related to the assessment of surgical innovation were incorporated in only a few studies. Organisational impact (capital investment in the surgical system) was mentioned in most studies but was only incorporated in 4 studies, learning curve was mentioned in 7 studies but incorporated in 2 studies, dynamic pricing was incorporated in 2 studies and incremental innovation was incorporated in 1 study.

CONCLUSIONS: Multiple economic evaluation methods for RAS were identified. However, most studies of RAS typically focused on a single specialty. Although certain studies incorporated the challenges associated with RAS, the evaluation rarely accounted for RAS as a platform technology spanning multiple specialties. Thus, there remains a need to consider this aspect when conducting economic evaluations to capture the full value of RAS.