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Robotic Versus Open Mitral Valve Repair: A Cost-utility Analysis
Arian Arjomandi Rad1, Ali Ansaripour
1, Robert Vardanyan
2, Dimitrios Magouliotis
3, Antonios Kourliouros
1, Thanos Athanasiou
2;
1John Radcliffe Hospital - Oxford University Hospitals NHS Trust, Oxford, United Kingdom,
2Imperial College London, London, United Kingdom,
3University Hospital of Larissa, Larissa, Greece
BACKGROUND: Mitral valve regurgitation (MR) is a common valvular heart disease that poses significant treatment challenges. This study aims to compare the economic and health outcomes of two surgical interventions for MR: traditional open surgical repair and robotic minimally invasive surgical repair.
METHODS:We conducted an extensive literature review using databases such as MEDLINE and EMBASE, focusing on studies that evaluated the clinical and economic outcomes of these surgical approaches. Our analysis included the intraoperative and postoperative costs, as well as the costs associated with the most common complications of each procedure. We calculated Quality Adjusted Life Years (QALYs) to assess the cost-effectiveness of robotic surgery against the National Institute for Health and Care Excellence (NICE) threshold of £30,000/QALY. A discount factor was applied to account for the greater value of present and past costs compared to future costs.
RESULTS:The average cost of robotic surgery was $24,356.22, compared to $23,277.30 for open surgery. The Incremental Cost-Effectiveness Ratio (ICER) for robotic surgery was £4781.44/QALY. This indicates that adopting robotic surgery as the standard practice would cost the NHS an additional £4781.44 per QALY gained per patient. Robotic surgery is associated with fewer complications and a cost per QALY that is below the NICE upper threshold of £30,000/QALY, suggesting it is a viable alternative to open mitral valve repair. A sensitivity analysis, including the initial capital investment for robotic equipment, yielded an ICER of £22,379.94/QALY, which remains below the NICE threshold.
CONCLUSIONS: Robotic mitral valve surgery, despite its higher initial costs, proves to be a cost-effective option when considering its long-term health benefits and lower rate of postoperative complications. It presents a feasible alternative to traditional open surgery, particularly in light of the QALYs gained and the overall reduction in postoperative complications. These findings advocate for the increased adoption of robotic surgery in healthcare systems and underscore the importance of further research into long-term patient outcomes. and the evolving economic landscape of robotic surgery.
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