DOI: 10.1097/sla.0000000000007188 ISSN: 0003-4932

Cost-effectiveness Analysis of Robotic Versus Open Pancreatoduodenectomy (DIPLOMA-2)

Julia E. Menso, Caro L. Bruna, de Graaf Nine, Anouk M.L.H. Emmen, Mahsoem Ali, Bergthor Björnsson, Ugo Boggi, Olivier R. Busch, Annalisa Comandatore, Freek Daams, Giovanni Ferrari, Sebastiaan Festen, Jony van Hilst, Ignace H.J.T. de Hingh, Mathieu D’Hondt, Benedetto Ielpo, Tobias Keck, Bas Groot Koerkamp, Daan J. Lips, Misha D.P. Luyer, J. Sven Mieog, Luca Morelli, I. Quintus Molenaar, Marco Ramera, Francesco Sucameli, Roeland F. de Wilde, Patrick Maisonneuve, Gudrun M.W. Björnelv, Mohammad Abu Hilal, Marc G. Besselink, Åsmund A. Fretland,
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Background:

Although robot-assisted pancreatoduodenectomy (RPD) enhances patient recovery, it could be associated with higher costs than open pancreatoduodenectomy (OPD), potentially limiting its widespread adoption. High-level evidence comparing costs of RPD and OPD is lacking. This analysis in a randomized trial compared costs and cost-effectiveness between RPD and OPD.

Methods:

Predefined cost-effectiveness analysis in the international randomized DIPLOMA-2 trial (ISRCTN27483786) comparing RPD and OPD in patients with primary resectable neoplasm in 14 centers in 6 European countries (2022–2023). Primary outcomes were mean total hospital costs (euro) at 6 months postoperatively and cost-effectiveness based on costs per quality-adjusted life year (QALY; incremental cost-utility ratio). Three analyses were performed: (1) costs, (2) QALYs including Health-Related Quality of Life (HR-QoL), and (3) cost-effectiveness with probabilities at various willingness-to-pay (WTP) thresholds.

Results:

Overall, 268 patients were included (170 RPD, 98 OPD). No significant difference in total hospital costs was found between RPD and OPD (€30,956 vs. €28,271, P =0.538). The intraoperative costs were €5,491 higher with RPD (€11,906 vs. €6,451, P <0.001), whereas postoperative costs were €2806 lower (€19,051 vs. €21,856, P =0.518). The HR-QoL index scores were comparable at 1 and 3 months, but worse at 6 months with RPD (Δ−0.08 [−0.15 to −0.001]). Consequently, over 6 months a QALY loss was observed with RPD (Δ−0.02 [−0.07 to 0.01]) with a <30% probability of RPD being cost-effective across various WTP thresholds.

Conclusion:

This analysis in a randomized trial found no significant differences in costs between RPD and OPD up to 6 months. Nonsignificantly lower QALYs at 6 months with RPD resulted in a <30% probability that RPD is cost-effective compared with OPD within 6 months after surgery in selected patients in high-volume centers.

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