OBJECTIVES: The robotic surgery cost presents a critical issue which has not been well addressed yet. This study aims to compare the clinical outcomes and cost-effective outcomes of robotic distal pancreatectomy (RDP) versus laparoscopic distal pancreatectomy (LDP).

METHODS: This is a clinical and cost-effectiveness analysis within a retrospective comparative study of RDP and LDP conducted at Sanchinarro University Hospital from 2011 to 2017. Outcome parameters included surgical and post-operative costs, quality adjusted life years (QALY), and incremental cost per QALY gained or the incremental cost effectiveness ratio (ICER). A sensitivity analysis was carried out in order to propagate the uncertainty of the estimations to the results of the model. We use a multivariate and stochastic sensitivity analysis performed by 5000 Monte Carlo simulations. The cost-effectiveness plane was used to represent all pairs of solutions of the model.

RESULTS: A total of 28 RDP and 26 LDP have been included. Conversion rate resulted to be significative higher in the LDP (3.6% vs 19.2%; p = 0.04). The overall rate of pancreatic leak was 10.7% in the RDP group and 15.4% in the LDP group (p > 0.5). The mean number of hospital stay days was significative higher in the LDP (8.9 days vs 16.9 days, p = 0.03). The mean operative time was higher in the RDP (294 vs 241 min; p = 0.02). The overall mean total cost was similar in both groups (RDP: 9198.64€versus LDP: 9399.74€; P > 0.5). Mean QALYs at 1 year for RDP (0.622) was higher than that associated with LDP (0.60025) (p>0.5). At a willingness-to-pay threshold of 20000 € and 30000 €, there was a 63.58% and 76.69% probability that RDP was cost-effective relative to LDP

CONCLUSIONS: RDP procedure appears to be cost-effective compared with LDP.