OBJECTIVES : This systematic literature review aims to assess the current literature on cost-effectiveness studies of robotic-assisted radical prostatectomy (RRP) for prostate cancer.

METHODS : A systematic search in PubMed, Scopus and Embase databases was conducted from 2004-2018 to identify studies that assessed the cost-effectiveness of RRP. Additional grey literature search was conducted to identify Health Technology Assessment (HTA) reports. Study quality was assessed by the Consolidated Health Economic Evaluation Reporting Standards (CHEERS). Structured narrative synthesis was performed.

RESULTS : Of 9 publications identified (6 peer-reviewed studies and 3 HTA reports), all were conducted from societal or payer perspectives. The studies were from 7 countries with different healthcare systems, willingness-to-pay (WTP) thresholds, and discount rates.

The comparators for RRP were open radical prostatectomy (ORP) (7 studies/78%), and laparoscopic radical prostatectomy (LRP) (3 studies/33%). RRP was also compared with other non-surgical treatments in 2 studies. Seven studies (78%) were simulation-based cost-effectiveness (4 Markov and 1 decision tree models). Capital and maintenance costs were included in 7 studies (78%).

Time horizons ranged from perioperative periods, 1 year to lifetime, and had significant impact on results. Among the 2 studies that only considered short-term time horizon, RRP was either dominated by ORP or not cost-effective, while a lifetime CEA from the USA payer perspective showed RRP to be dominant over ORP and LRP. Three studies with 7+ year time horizons showed ICERs of RRP to be below the WTP thresholds for UK, Ireland and Alberta Canada payer perspectives, respectively.

Among 6 studies that evaluated procedure volume, an increase in the number of cases per system was associated with better economic value of RRP.

CONCLUSIONS : Different methodologies used to evaluate cost-effectiveness for RRP led to inconsistent results. Analyses with longer time horizon and larger procedure volumes showed cost-effectiveness results more favorable towards RRP.