Cost-effectiveness Analysis of Robotic-assisted Lobectomy for Non-small Cell Lung Cancer

Abstract Background Robot-assisted thoracic surgery has emerged as an alternative to video-assisted thoracic surgery (VATS) for treating patients with resectable non-small cell lung cancer (NSCLC). The objective of this study was to evaluate the cost-effectiveness of robotic-assisted lobectomy (RAL) compared to VATS and open lobectomy for adults with NSCLC. Methods A decision analysis model was employed to compare the cost-effectiveness of RAL, VATS, and open lobectomy with 1-year time horizon from both healthcare and societal perspectives. Healthcare costs (2020$) and quality-adjusted life-years (QALYs) were compared between the approaches. Incremental cost-effectiveness ratios (ICERs) were calculated in terms of cost per QALY gained. Sensitivity analyses were performed to identify variables driving cost-effectiveness across several willingness-to-pay (WTP) thresholds. Results Open thoracotomy was not cost-effective compared to both RAL and VATS lobectomy. From the healthcare sector perspective, RAL was $394.97 more expensive per case than VATS resulting in an ICER of $180,755.10 per QALY. From the societal perspective, RAL was $247.77 more expensive per case than VATS, resulting in an ICER of $113,388.80 per QALY. RAL becomes cost-effective with marginally lower robotic instrument costs, shorter operating room times, lower conversion rates, shorter lengths of stay, higher hospital volumes, and improved quality of life. RAL is also cost-effective if surgeons can increase the proportion of minimally invasive lobectomies using robotic technology. Conclusions Compared to VATS, RAL is not cost-effective for lung cancer lobectomy at lower WTP thresholds. However, several factors may drive RAL to emerge as the more cost-effective approach for minimally invasive lung cancer resection.