Cost-effectiveness of robotic compared with laparoscopic rectal resection. Results from the Spanish prospective national trial ROBOCOSTES

Maria-Alejandra Guerrero; Gianluca Pellino; Marta Gimeno; Sandra Alonso-Marsol; Mauro Podda; Miguel Toledano; Javier Núñez-Alfonsel; Lucio Selvaggi; M.A. Acosta Mérida; Juan Bellido-Luque; Benedetto Ielpo; Luis Sánchez Guillén; Carlos Javier Diaz Lara; José Francisco Noguera Aguilar; Julián García Orozco; Manuel González Bermúdez; Sandra Castro Boix; Amaia Gantxegi; Eloy Espin-Basany; Miquel Kraft; Elizabeth Pando; Nair Fernandes; Manuel López Cano; David Fernández Luengas; Jorge Zárate Gómez; Pedro Álvarez de Sierra Hernández; Raquel Sánchez-Santos; O. Cano-Valderrama; Manuel Nogueira Sixto; Nicolás Álvarez Garrido; Marta Iglesias Trigo; Marcel Pujadas; Clara Codony Bassols; Nuria Ortega-Torrecilla; Pere Planellas Giné; Santiago López-Ben; Emilio Vicente; Ricardo Caruso; Valentina Ferri; Helena Álvarez García; Aro Abascal Amo; Javier Etreros Alonso; Sagrario Martinez Cortijo; Manuel Alberto Lasaia; Santiago Linacero; Ana Pilar Morante; Juan Carlos Martín Del Olmo; Mario Álvarez Gallego; Jenny Guevara; Eduardo Gutiérrez Iscar; Sergio Pedro Olivares Pizarro; Raquel Ríos Blanco; Benito Miguel Josa Martínez; David Pacheco Sánchez; Vicente Simó; Javier Sánchez González; Jacobo Trébol; Luis Alfredo Tresierra Carranza; David Alías Jiménez; Gustavo Díaz García; Héctor Guadalajara; Miguel León Arellano; Rosa Jorba; Sonia Babiloni Simón; Ismael Díez Del Val; Joseba Castro Vázquez; Nuria Ortega; Carlos Pastor; Jorge Arredondo Chaves

doi:10.1016/j.surg.2024.109134

Cost-effectiveness of robotic compared with laparoscopic rectal resection. Results from the Spanish prospective national trial ROBOCOSTES

Maria-Alejandra Guerrero, Gianluca Pellino, Marta Gimeno, Sandra Alonso-Marsol, Mauro Podda, Miguel Toledano, Javier Núñez-Alfonsel, Lucio Selvaggi, M.A. Acosta Mérida, Juan Bellido-Luque, Benedetto Ielpo, Luis Sánchez Guillén, Carlos Javier Diaz Lara, José Francisco Noguera Aguilar, Julián García Orozco, Manuel González Bermúdez, Sandra Castro Boix, Amaia Gantxegi, Eloy Espin-Basany, Miquel KraftElizabeth Pando, Nair Fernandes, Manuel López Cano, David Fernández Luengas, Jorge Zárate Gómez, Pedro Álvarez de Sierra Hernández, Raquel Sánchez-Santos, O. Cano-Valderrama, Manuel Nogueira Sixto, Nicolás Álvarez Garrido, Marta Iglesias Trigo, Marcel Pujadas, Clara Codony Bassols, Nuria Ortega-Torrecilla, Pere Planellas Giné, Santiago López-Ben, Emilio Vicente, Ricardo Caruso, Valentina Ferri, Helena Álvarez García, Aro Abascal Amo, Javier Etreros Alonso, Sagrario Martinez Cortijo, Manuel Alberto Lasaia, Santiago Linacero, Ana Pilar Morante, Juan Carlos Martín Del Olmo, Mario Álvarez Gallego, Jenny Guevara, Eduardo Gutiérrez Iscar, Sergio Pedro Olivares Pizarro, Raquel Ríos Blanco, Benito Miguel Josa Martínez, David Pacheco Sánchez, Vicente Simó, Javier Sánchez González, Jacobo Trébol, Luis Alfredo Tresierra Carranza, David Alías Jiménez, Gustavo Díaz García, Héctor Guadalajara, Miguel León Arellano, Rosa Jorba, Sonia Babiloni Simón, Ismael Díez Del Val, Joseba Castro Vázquez, Nuria Ortega, Carlos Pastor, Jorge Arredondo Chaves

Departament de Cirurgia

Producció científica: Contribució a revista › Article › Recerca › Avaluat per experts

11 Cites (Scopus)

Resum

Objective: The costs related to robotic surgery are known to be greater than those associated with laparoscopy. However, the potential for better outcomes of the former could lead to a cost-effectiveness advantage. The aim of this study is therefore to highlight the difference in cost-effectiveness between robotic and laparoscopic rectal resection. Methods: This is an observational, multicenter, national prospective study (ROBOCOSTES). From 2022, for 1 year, all consecutive patients undergoing minimally invasive rectal resection were included. Quality-adjusted life year and cost data were prospectively collected. The primary aim was to assess the cost-effectiveness of robotic rectal resection and laparoscopic rectal resection. Secondary aims included clinical outcomes and quality of life. Results: Overall, 182 patients underwent rectal resection (152 anterior and 30 abdominoperineal excisions) at 14 centers, of whom 95 received robotic rectal resection and 87 laparoscopic rectal resection. Robotic rectal resection was associated with lesser blood loss (58.55 ± 51.68 vs 131.68 ± 191.92, P <.001), lower pain score at day 1 (-1.04 visual analog scale, P <.001) and day 7 (-0.81, P <.001) after surgery, and with fewer hospital readmissions (2.1% vs 15%, P =.005) compared with laparoscopic rectal resection. The overall costs of robotic rectal resection (including hospitalization) were 919.66 euros greater compared with laparoscopic rectal resection, but quality-adjusted life years in the robotic rectal resection group were better than laparoscopic approaches to rectal resection both at 30-day (0.8914 vs 0.8139) and 90-day (0.9573 vs 0.8740) follow-up. At a willingness-to-pay threshold of 20,000 and 30,000 euros, there was an 84.38% and 89.36% probability that robotic rectal resection was more cost-effective than laparoscopic rectal resection. Conclusion: This study showed that robotic rectal resection, even if associated with greater direct costs in the short term, outperforms laparoscopic rectal resection in terms of quality-adjusted life years and should therefore be preferred where available.

Idioma original	Anglès
Revista	Surgery
Volum	180
DOIs	https://doi.org/10.1016/j.surg.2024.109134
Estat de la publicació	En premsa - 2025

SDG de les Nacions Unides

Aquest resultat contribueix als següents objectius de desenvolupament sostenible.

Accés al document

10.1016/j.surg.2024.109134

https://ddd.uab.cat/record/325000

Com citar-ho

Guerrero, M.-A., Pellino, G., Gimeno, M., Alonso-Marsol, S., Podda, M., Toledano, M., Núñez-Alfonsel, J., Selvaggi, L., Acosta Mérida, M. A., Bellido-Luque, J., Ielpo, B., Sánchez Guillén, L., Diaz Lara, C. J., Noguera Aguilar, J. F., García Orozco, J., González Bermúdez, M., Castro Boix, S., Gantxegi, A., Espin-Basany, E., ... Arredondo Chaves, J. (Acceptat/En premsa). Cost-effectiveness of robotic compared with laparoscopic rectal resection. Results from the Spanish prospective national trial ROBOCOSTES. Surgery, 180. https://doi.org/10.1016/j.surg.2024.109134

@article{d8d8dec3c84248159ce8d36c9dd9db4f,

title = "Cost-effectiveness of robotic compared with laparoscopic rectal resection. Results from the Spanish prospective national trial ROBOCOSTES",

abstract = "Objective: The costs related to robotic surgery are known to be greater than those associated with laparoscopy. However, the potential for better outcomes of the former could lead to a cost-effectiveness advantage. The aim of this study is therefore to highlight the difference in cost-effectiveness between robotic and laparoscopic rectal resection. Methods: This is an observational, multicenter, national prospective study (ROBOCOSTES). From 2022, for 1 year, all consecutive patients undergoing minimally invasive rectal resection were included. Quality-adjusted life year and cost data were prospectively collected. The primary aim was to assess the cost-effectiveness of robotic rectal resection and laparoscopic rectal resection. Secondary aims included clinical outcomes and quality of life. Results: Overall, 182 patients underwent rectal resection (152 anterior and 30 abdominoperineal excisions) at 14 centers, of whom 95 received robotic rectal resection and 87 laparoscopic rectal resection. Robotic rectal resection was associated with lesser blood loss (58.55 ± 51.68 vs 131.68 ± 191.92, P <.001), lower pain score at day 1 (-1.04 visual analog scale, P <.001) and day 7 (-0.81, P <.001) after surgery, and with fewer hospital readmissions (2.1\% vs 15\%, P =.005) compared with laparoscopic rectal resection. The overall costs of robotic rectal resection (including hospitalization) were 919.66 euros greater compared with laparoscopic rectal resection, but quality-adjusted life years in the robotic rectal resection group were better than laparoscopic approaches to rectal resection both at 30-day (0.8914 vs 0.8139) and 90-day (0.9573 vs 0.8740) follow-up. At a willingness-to-pay threshold of 20,000 and 30,000 euros, there was an 84.38\% and 89.36\% probability that robotic rectal resection was more cost-effective than laparoscopic rectal resection. Conclusion: This study showed that robotic rectal resection, even if associated with greater direct costs in the short term, outperforms laparoscopic rectal resection in terms of quality-adjusted life years and should therefore be preferred where available.",

keywords = "Rectal cancer, Laparoscopy, Robotic, Robotic assisted, Cost effectiveness",

author = "Maria-Alejandra Guerrero and Gianluca Pellino and Marta Gimeno and Sandra Alonso-Marsol and Mauro Podda and Miguel Toledano and Javier N{\'u}{\~n}ez-Alfonsel and Lucio Selvaggi and \{Acosta M{\'e}rida\}, M.A. and Juan Bellido-Luque and Benedetto Ielpo and \{S{\'a}nchez Guill{\'e}n\}, Luis and \{Diaz Lara\}, \{Carlos Javier\} and \{Noguera Aguilar\}, \{Jos{\'e} Francisco\} and \{Garc{\'i}a Orozco\}, Juli{\'a}n and \{Gonz{\'a}lez Berm{\'u}dez\}, Manuel and \{Castro Boix\}, Sandra and Amaia Gantxegi and Eloy Espin-Basany and Miquel Kraft and Elizabeth Pando and Nair Fernandes and \{L{\'o}pez Cano\}, Manuel and \{Fern{\'a}ndez Luengas\}, David and \{Z{\'a}rate G{\'o}mez\}, Jorge and \{{\'A}lvarez de Sierra Hern{\'a}ndez\}, Pedro and Raquel S{\'a}nchez-Santos and O. Cano-Valderrama and \{Nogueira Sixto\}, Manuel and \{{\'A}lvarez Garrido\}, Nicol{\'a}s and \{Iglesias Trigo\}, Marta and Marcel Pujadas and \{Codony Bassols\}, Clara and Nuria Ortega-Torrecilla and \{Planellas Gin{\'e}\}, Pere and Santiago L{\'o}pez-Ben and Emilio Vicente and Ricardo Caruso and Valentina Ferri and \{{\'A}lvarez Garc{\'i}a\}, Helena and \{Abascal Amo\}, Aro and \{Etreros Alonso\}, Javier and \{Martinez Cortijo\}, Sagrario and \{Alberto Lasaia\}, Manuel and Santiago Linacero and Morante, \{Ana Pilar\} and \{Mart{\'i}n Del Olmo\}, \{Juan Carlos\} and \{{\'A}lvarez Gallego\}, Mario and Jenny Guevara and \{Guti{\'e}rrez Iscar\}, Eduardo and \{Olivares Pizarro\}, \{Sergio Pedro\} and \{R{\'i}os Blanco\}, Raquel and \{Josa Mart{\'i}nez\}, \{Benito Miguel\} and \{Pacheco S{\'a}nchez\}, David and Vicente Sim{\'o} and \{S{\'a}nchez Gonz{\'a}lez\}, Javier and Jacobo Tr{\'e}bol and \{Tresierra Carranza\}, \{Luis Alfredo\} and \{Al{\'i}as Jim{\'e}nez\}, David and \{D{\'i}az Garc{\'i}a\}, Gustavo and H{\'e}ctor Guadalajara and \{Le{\'o}n Arellano\}, Miguel and Rosa Jorba and \{Babiloni Sim{\'o}n\}, Sonia and \{D{\'i}ez Del Val\}, Ismael and \{Castro V{\'a}zquez\}, Joseba and Nuria Ortega and Carlos Pastor and \{Arredondo Chaves\}, Jorge",

year = "2025",

doi = "10.1016/j.surg.2024.109134",

language = "English",

volume = "180",

journal = "Surgery",

issn = "0039-6060",

publisher = "Elsevier Inc.",

}

Guerrero, M-A, Pellino, G, Gimeno, M, Alonso-Marsol, S, Podda, M, Toledano, M, Núñez-Alfonsel, J, Selvaggi, L, Acosta Mérida, MA, Bellido-Luque, J, Ielpo, B, Sánchez Guillén, L, Diaz Lara, CJ, Noguera Aguilar, JF, García Orozco, J, González Bermúdez, M, Castro Boix, S, Gantxegi, A, Espin-Basany, E, Kraft, M, Pando, E, Fernandes, N, López Cano, M, Fernández Luengas, D, Zárate Gómez, J, Álvarez de Sierra Hernández, P, Sánchez-Santos, R, Cano-Valderrama, O, Nogueira Sixto, M, Álvarez Garrido, N, Iglesias Trigo, M, Pujadas, M, Codony Bassols, C, Ortega-Torrecilla, N, Planellas Giné, P, López-Ben, S, Vicente, E, Caruso, R, Ferri, V, Álvarez García, H, Abascal Amo, A, Etreros Alonso, J, Martinez Cortijo, S, Alberto Lasaia, M, Linacero, S, Morante, AP, Martín Del Olmo, JC, Álvarez Gallego, M, Guevara, J, Gutiérrez Iscar, E, Olivares Pizarro, SP, Ríos Blanco, R, Josa Martínez, BM, Pacheco Sánchez, D, Simó, V, Sánchez González, J, Trébol, J, Tresierra Carranza, LA, Alías Jiménez, D, Díaz García, G, Guadalajara, H, León Arellano, M, Jorba, R, Babiloni Simón, S, Díez Del Val, I, Castro Vázquez, J, Ortega, N, Pastor, C & Arredondo Chaves, J 2025, 'Cost-effectiveness of robotic compared with laparoscopic rectal resection. Results from the Spanish prospective national trial ROBOCOSTES', Surgery, vol. 180. https://doi.org/10.1016/j.surg.2024.109134

TY - JOUR

T1 - Cost-effectiveness of robotic compared with laparoscopic rectal resection. Results from the Spanish prospective national trial ROBOCOSTES

AU - Guerrero, Maria-Alejandra

AU - Pellino, Gianluca

AU - Gimeno, Marta

AU - Alonso-Marsol, Sandra

AU - Podda, Mauro

AU - Toledano, Miguel

AU - Núñez-Alfonsel, Javier

AU - Selvaggi, Lucio

AU - Acosta Mérida, M.A.

AU - Bellido-Luque, Juan

AU - Ielpo, Benedetto

AU - Sánchez Guillén, Luis

AU - Diaz Lara, Carlos Javier

AU - Noguera Aguilar, José Francisco

AU - García Orozco, Julián

AU - González Bermúdez, Manuel

AU - Castro Boix, Sandra

AU - Gantxegi, Amaia

AU - Espin-Basany, Eloy

AU - Kraft, Miquel

AU - Pando, Elizabeth

AU - Fernandes, Nair

AU - López Cano, Manuel

AU - Fernández Luengas, David

AU - Zárate Gómez, Jorge

AU - Álvarez de Sierra Hernández, Pedro

AU - Sánchez-Santos, Raquel

AU - Cano-Valderrama, O.

AU - Nogueira Sixto, Manuel

AU - Álvarez Garrido, Nicolás

AU - Iglesias Trigo, Marta

AU - Pujadas, Marcel

AU - Codony Bassols, Clara

AU - Ortega-Torrecilla, Nuria

AU - Planellas Giné, Pere

AU - López-Ben, Santiago

AU - Vicente, Emilio

AU - Caruso, Ricardo

AU - Ferri, Valentina

AU - Álvarez García, Helena

AU - Abascal Amo, Aro

AU - Etreros Alonso, Javier

AU - Martinez Cortijo, Sagrario

AU - Alberto Lasaia, Manuel

AU - Linacero, Santiago

AU - Morante, Ana Pilar

AU - Martín Del Olmo, Juan Carlos

AU - Álvarez Gallego, Mario

AU - Guevara, Jenny

AU - Gutiérrez Iscar, Eduardo

AU - Olivares Pizarro, Sergio Pedro

AU - Ríos Blanco, Raquel

AU - Josa Martínez, Benito Miguel

AU - Pacheco Sánchez, David

AU - Simó, Vicente

AU - Sánchez González, Javier

AU - Trébol, Jacobo

AU - Tresierra Carranza, Luis Alfredo

AU - Alías Jiménez, David

AU - Díaz García, Gustavo

AU - Guadalajara, Héctor

AU - León Arellano, Miguel

AU - Jorba, Rosa

AU - Babiloni Simón, Sonia

AU - Díez Del Val, Ismael

AU - Castro Vázquez, Joseba

AU - Ortega, Nuria

AU - Pastor, Carlos

AU - Arredondo Chaves, Jorge

PY - 2025

Y1 - 2025

N2 - Objective: The costs related to robotic surgery are known to be greater than those associated with laparoscopy. However, the potential for better outcomes of the former could lead to a cost-effectiveness advantage. The aim of this study is therefore to highlight the difference in cost-effectiveness between robotic and laparoscopic rectal resection. Methods: This is an observational, multicenter, national prospective study (ROBOCOSTES). From 2022, for 1 year, all consecutive patients undergoing minimally invasive rectal resection were included. Quality-adjusted life year and cost data were prospectively collected. The primary aim was to assess the cost-effectiveness of robotic rectal resection and laparoscopic rectal resection. Secondary aims included clinical outcomes and quality of life. Results: Overall, 182 patients underwent rectal resection (152 anterior and 30 abdominoperineal excisions) at 14 centers, of whom 95 received robotic rectal resection and 87 laparoscopic rectal resection. Robotic rectal resection was associated with lesser blood loss (58.55 ± 51.68 vs 131.68 ± 191.92, P <.001), lower pain score at day 1 (-1.04 visual analog scale, P <.001) and day 7 (-0.81, P <.001) after surgery, and with fewer hospital readmissions (2.1% vs 15%, P =.005) compared with laparoscopic rectal resection. The overall costs of robotic rectal resection (including hospitalization) were 919.66 euros greater compared with laparoscopic rectal resection, but quality-adjusted life years in the robotic rectal resection group were better than laparoscopic approaches to rectal resection both at 30-day (0.8914 vs 0.8139) and 90-day (0.9573 vs 0.8740) follow-up. At a willingness-to-pay threshold of 20,000 and 30,000 euros, there was an 84.38% and 89.36% probability that robotic rectal resection was more cost-effective than laparoscopic rectal resection. Conclusion: This study showed that robotic rectal resection, even if associated with greater direct costs in the short term, outperforms laparoscopic rectal resection in terms of quality-adjusted life years and should therefore be preferred where available.

AB - Objective: The costs related to robotic surgery are known to be greater than those associated with laparoscopy. However, the potential for better outcomes of the former could lead to a cost-effectiveness advantage. The aim of this study is therefore to highlight the difference in cost-effectiveness between robotic and laparoscopic rectal resection. Methods: This is an observational, multicenter, national prospective study (ROBOCOSTES). From 2022, for 1 year, all consecutive patients undergoing minimally invasive rectal resection were included. Quality-adjusted life year and cost data were prospectively collected. The primary aim was to assess the cost-effectiveness of robotic rectal resection and laparoscopic rectal resection. Secondary aims included clinical outcomes and quality of life. Results: Overall, 182 patients underwent rectal resection (152 anterior and 30 abdominoperineal excisions) at 14 centers, of whom 95 received robotic rectal resection and 87 laparoscopic rectal resection. Robotic rectal resection was associated with lesser blood loss (58.55 ± 51.68 vs 131.68 ± 191.92, P <.001), lower pain score at day 1 (-1.04 visual analog scale, P <.001) and day 7 (-0.81, P <.001) after surgery, and with fewer hospital readmissions (2.1% vs 15%, P =.005) compared with laparoscopic rectal resection. The overall costs of robotic rectal resection (including hospitalization) were 919.66 euros greater compared with laparoscopic rectal resection, but quality-adjusted life years in the robotic rectal resection group were better than laparoscopic approaches to rectal resection both at 30-day (0.8914 vs 0.8139) and 90-day (0.9573 vs 0.8740) follow-up. At a willingness-to-pay threshold of 20,000 and 30,000 euros, there was an 84.38% and 89.36% probability that robotic rectal resection was more cost-effective than laparoscopic rectal resection. Conclusion: This study showed that robotic rectal resection, even if associated with greater direct costs in the short term, outperforms laparoscopic rectal resection in terms of quality-adjusted life years and should therefore be preferred where available.

KW - Rectal cancer

KW - Laparoscopy

KW - Robotic

KW - Robotic assisted

KW - Cost effectiveness

U2 - 10.1016/j.surg.2024.109134

DO - 10.1016/j.surg.2024.109134

M3 - Article

C2 - 39879899

SN - 0039-6060

VL - 180

JO - Surgery

JF - Surgery

ER -