A systematic review of economic evaluations of the use of robotic assisted laparoscopy in surgery compared with open or laparoscopic surgery

Zafer Tandogdu, Luke Vale, Cynthia Fraser, Craig Ramsay

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Robot assisted laparoscopic (RAL) surgery, developed to overcome the limitations of laparoscopy to assist in surgical procedures, has high capital and operating costs. Systematically assembled evidence demonstrating its clinical and cost effectiveness would be helpful for its adoption by decision makers.

To summarise the evidence on the cost-effectiveness of RAL surgery compared with relevant alternatives. Methods and results of identified studies were assessed to identify the deficiencies in evidence and areas for further research.

Studies reporting both costs and outcomes for comparisons of RAL with laparoscopy and/or open surgery were systematically identified. Searches were conducted in February 2015 on MEDLINE, EMBASE and NHS EED. Quality of the included studies was assessed against a standard checklist for economic analyses. Length-of-hospital stay and operating time (determinants of cost), cost of intervention, quality-adjusted-life-years (QALYs) and incremental-cost-effectiveness ratio (ICER) were extracted. To aid comparison, costs were converted into a common currency and price year (2014 US dollars).

47 eligible studies were identified (full economic evaluation n=6 and cost-analysis n=41). Economic models were used in 11(23%) studies. Only three studies used a model considered representative of the disease and clinical pathway with a time-horizon allowing capture of relevant differences in outcomes across strategies.
The cost of RAL varied substantially between uses; ranging from US$7011 for hysterectomy to over US$30,000 for radical cystectomy. The majority of estimates were between US$15,000 and US$25,000 per person. In part this difference is explained by difference between studies in what costs were included. It was also identified to have higher costs than the alternatives it was compared against. Incremental cost per QALY for RAL radical prostatectomy was US$28,801-US$31,763 over a 10-year period assuming 200 cases per-annum.

The clinical evidence available for RAL overall and used within included studies is limited. RAL surgery costs were consistently higher than open and laparoscopic surgery. Therefore, adopting the robotic technology decision makers need to take into account the cost-effectiveness within their own systems. Economic models generated and published for radical prostatectomy and hysterectomy may be adapted to other health system if the care pathway is similar to provide locally relevant data.
Original languageEnglish
Pages (from-to)457-467
Number of pages11
JournalApplied Health Economics and Health Policy
Issue number5
Early online date4 Aug 2015
Publication statusPublished - Oct 2015

Bibliographical note

Compliance with ethical standards
Study funding and conflict of interest
Zafer Tandogdu is with a European Association of Urology scholarship (EUSP clinical fellowship) at Newcastle University, Medical School, Northern Institute for Cancer Research (NICR), Newcastle upon Tyne, UK. None of the authors have any conflicts of interest to declare.
No funding was granted for the independent work conducted


  • Radical Prostatectomy
  • Pelvic Organ Prolapse
  • Partial Nephrectomy
  • Clinical Pathway
  • Supplementary Appendix


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