Nationwide cost-effectiveness and quality of life analysis of minimally invasive distal pancreatectomy.

Cost analysis Laparoscopic distal pancreatectomy Minimally invasive pancreatectomy Pancreatic surgery Robotic distal pancreatectomy

Journal

Surgical endoscopy
ISSN: 1432-2218
Titre abrégé: Surg Endosc
Pays: Germany
ID NLM: 8806653

Informations de publication

Date de publication:
20 Aug 2024
Historique:
received: 14 02 2024
accepted: 08 04 2024
medline: 21 8 2024
pubmed: 21 8 2024
entrez: 20 8 2024
Statut: aheadofprint

Résumé

This study analyzed the Quality of Life (QoL) and cost-effectiveness of laparoscopic (LDP) versus robotic distal pancreatectomy (RDP). Consecutive patients submitted to LDP or RDP from 2010 to 2020 in four high-volume Italian centers were included, with a minimum of 12 months of postoperative follow-up were included. QoL was evaluated using the EORTC QLQ-C30 and EQ-5D questionnaires, self-reported by patients. After a propensity score matching, which included BMI, gender, operation time, multiorgan and vascular resections, splenic preservation, and pancreatic stump management, the mean differential cost and Quality-Adjusted Life Years (QALY) were calculated and plotted on a cost-utility plane. The study population consisted of 564 patients. Among these, 271 (49%) patients were submitted to LDP, while 293 (51%) patients to RDP. After propensity score matching, the study population was composed of 159 patients in each group, with a median follow-up of 59 months. As regards the QoL analysis, global health and emotional functioning domains showed better results in the RDP group (p = 0.037 and p = 0.026, respectively), whereas the other did not differ. As expected, the median crude costs analysis confirmed that RDP was more expensive than LDP (16,041 Euros vs. 10,335 Euros, p < 0.001). However, the robotic approach had a higher probability of being more cost-effective than the laparoscopic procedure when a willingness to pay more than 5697 Euros/QALY was accepted. RDP was associated with better QoL as explored by specific domains. Crude costs were higher for RDP, and the cost-effectiveness threshold was set at 5697 euros/QALY.

Sections du résumé

BACKGROUND BACKGROUND
This study analyzed the Quality of Life (QoL) and cost-effectiveness of laparoscopic (LDP) versus robotic distal pancreatectomy (RDP).
METHODS METHODS
Consecutive patients submitted to LDP or RDP from 2010 to 2020 in four high-volume Italian centers were included, with a minimum of 12 months of postoperative follow-up were included. QoL was evaluated using the EORTC QLQ-C30 and EQ-5D questionnaires, self-reported by patients. After a propensity score matching, which included BMI, gender, operation time, multiorgan and vascular resections, splenic preservation, and pancreatic stump management, the mean differential cost and Quality-Adjusted Life Years (QALY) were calculated and plotted on a cost-utility plane.
RESULTS RESULTS
The study population consisted of 564 patients. Among these, 271 (49%) patients were submitted to LDP, while 293 (51%) patients to RDP. After propensity score matching, the study population was composed of 159 patients in each group, with a median follow-up of 59 months. As regards the QoL analysis, global health and emotional functioning domains showed better results in the RDP group (p = 0.037 and p = 0.026, respectively), whereas the other did not differ. As expected, the median crude costs analysis confirmed that RDP was more expensive than LDP (16,041 Euros vs. 10,335 Euros, p < 0.001). However, the robotic approach had a higher probability of being more cost-effective than the laparoscopic procedure when a willingness to pay more than 5697 Euros/QALY was accepted.
CONCLUSION CONCLUSIONS
RDP was associated with better QoL as explored by specific domains. Crude costs were higher for RDP, and the cost-effectiveness threshold was set at 5697 euros/QALY.

Identifiants

DOI: 10.1007/s00464-024-10849-0 PMID: 39164438
pubmed: 39164438
doi: 10.1007/s00464-024-10849-0
pii: 10.1007/s00464-024-10849-0
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Subventions

Organisme : Intuitive Foundation
ID : Grant 2021

Informations de copyright

© 2024. The Author(s).

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Auteurs

Matteo De Pastena (M)

General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy.
ORCID: 0000-0001-5244-4357

Alessandro Esposito (A)

General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy.

Salvatore Paiella (S)

General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy.

Greta Montagnini (G)

General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy.

Caterina C Zingaretti (CC)

General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy.

Marco Ramera (M)

General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy.
Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.

Danila Azzolina (D)

Department of Environmental and Preventive Science, University of Ferrara, Ferrara, Italy.

Dario Gregori (D)

Unit of Biostatistics, Epidemiology, and Public Health, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Padova, Italy.

Emanuele F Kauffmann (EF)

Division of General and Transplant Surgery, Pisa University Hospital, Pisa, Italy.

Alessandro Giardino (A)

HPB Surgery Unit, Pederzoli Hospital, Peschiera del Garda, Verona, Italy.

Luca Moraldi (L)

Division of Oncologic Surgery and Robotics, Department of Oncology, Careggi University Hospital, Florence, Italy.

Giovanni Butturini (G)

HPB Surgery Unit, Pederzoli Hospital, Peschiera del Garda, Verona, Italy.

Ugo Boggi (U)

Division of General and Transplant Surgery, Pisa University Hospital, Pisa, Italy.

Roberto Salvia (R)

University of Verona, Verona, Italy. roberto.salvia@univr.it.
Unit of General and Pancreatic Surgery - The Pancreas Institute Verona, Department of Engineering for Innovation Medecine, University of Verona, Verona, Italy. roberto.salvia@univr.it.

Classifications MeSH