Cost-effectiveness Analysis of Robotic Versus Open Pancreatoduodenectomy (DIPLOMA-2): A Multicenter International Randomized Trial.
Julia E Menso, Caro L Bruna, Nine de Graaf et al.
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In 30 seconds
This predefined cost-effectiveness analysis of the multicenter international randomized DIPLOMA-2 trial compared robot-assisted with open pancreatoduodenectomy in patients with primary resectable neoplasms treated at 14 centers in six European countries. Among 268 patients, mean total hospital costs through six months did not differ significantly (€30,956 vs. €28,271; P =0.538). Quality-of-life scores were worse with robotic surgery at six months, and the estimated QALY difference was Δ-0.02 [-0.07 to 0.01]. The probability that robotic surgery was cost-effective across willingness-to-pay thresholds was <30%.
Key findings
- Total hospital costs were €30,956 with robotic and €28,271 with open surgery, with no significant difference (P =0.538).
- Intraoperative costs were €5,491 higher with robotic surgery (€11,906 vs. €6,451; P <0.001).
- At six months, the QALY difference was Δ-0.02 [-0.07 to 0.01], and robotic surgery had a <30% probability of being cost-effective across willingness-to-pay thresholds.
Why it matters
The findings show that higher intraoperative costs with robotic surgery were not offset by significantly lower total hospital costs over six months. The reported quality-of-life and QALY results also did not favour robotic surgery in this period. These data help frame the economic trade-offs of the two approaches in selected patients treated at high-volume centres.
What to keep in mind
The analysis covers costs and outcomes only through six months after surgery; its conclusions therefore do not establish longer-term cost-effectiveness.