A COST UTILITY ANALYSIS OF LAPAROSCOPIC SURGERY AND ROBOTIC SURGERY FOR REMOVAL OF THE PROSTATE IN MEN WITH LOCALISED PROSTATE CACER IN THAILAND

Abstract

Introduction: Robotic machines are being increasingly used and purchased in the treatment of clinically localized prostate cancer in Thailand. While the robotics may offer some advantages, it remains uncertain whether potential benefits offset higher costs. Subsequently, the aim of this study is to evaluate cost utility between standard and robotic assisted laparoscopic prostatectomy from the social perspective. Method: We created a care pathway and model for cost utility analysis. All variables used in our model were derived from the literature review, except cost, utility for erectile dysfunction and for urinary incontinence that were derived from Chulalongkorn Hospital and set in baht as of 2012. A positive margin was used to simulate the model. Sensitivity analysis was prepared to estimate the outcome. Result: The Thai utility values for erectile dysfunction and urinary incontinence were 0.86 and 0.81 respectively. Robotic laparoscopy was on average 120,359 baht (95% CI, 89,368 -151,350 baht) more costly than standard laparoscopy and was more effective with a mean gain in QALYs of 0.05 (95% CI, 0.03-0.08) of 100 procedures per year. The ICER was 2,407,180 baht with a 0% probability that robotic prostatectomy was cost effective at the Thai willingness to pay threshold of 160,000 baht/QALY. Conclusion: Our study has not found robotic approaches to be more cost effective than standard laparoscopy for the 100 cases performed each year. Increasing the number of cases might result in the willingness of the decision maker to pay the threshold.