How can robot-assisted surgery provide value for money?

Sejal Patel; Maroeska M Rovers; Michiel J P Sedelaar; Petra L M Zusterzeel; Ad F T M Verhagen; Camiel Rosman; Janneke P C Grutters

doi:10.1136/bmjsit-2020-000042

How can robot-assisted surgery provide value for money?

BMJ Surg Interv Health Technol. 2021 Feb 5;3(1):e000042. doi: 10.1136/bmjsit-2020-000042. eCollection 2021.

Authors

Sejal Patel¹, Maroeska M Rovers^{1

2}, Michiel J P Sedelaar³, Petra L M Zusterzeel⁴, Ad F T M Verhagen⁵, Camiel Rosman⁶, Janneke P C Grutters¹

Affiliations

¹ Department of Operating Rooms, Radboudumc, Nijmegen, Gelderland, The Netherlands.
² Operating Rooms and Health Evidence, Radboud Universiteit, Nijmegen, The Netherlands.
³ Department of Urology, Radboudumc, Nijmegen, Gelderland, The Netherlands.
⁴ Department of Obstetrics and Gynecology, Radboudumc, Nijmegen, Gelderland, The Netherlands.
⁵ Department of Cardiothoracic Surgery, Radboudumc, Nijmegen, Gelderland, The Netherlands.
⁶ Department of Surgery, Radboudumc, Nijmegen, Gelderland, The Netherlands.

Abstract

Objectives: To develop an interactive tool that estimates what potential benefits are needed for the robot to provide value for money when compared with endoscopic or open surgical interventions.

Design: A generic online interactive tool was developed to analyze the (health) effects needed to compensate for the additional costs of using a surgical robotic system from a healthcare perspective. The application of the tool is illustrated with a hypothetical new surgical robotic platform. A synthesis of evidence from different sources was used combined with interviews with surgeons.

Setting: Flexible tool that can be adapted to flexible settings.

Participants: Any hospital patient group for which robotic, endoscopic or open surgical procedures may be considered as appropriate treatment alternatives (eg, urology, gynecology, and so on).

Intervention: Robotically assisted surgical interventions.

Comparator: Endoscopic or open surgical interventions.

Main outcome measures: Thresholds of how much (health) effect is needed for robot-assisted surgery to provide value for money and to become cost-effective.

Results: The utilization rate of the surgical robotic system and a reduction in complications appeared to be important aspects in determining the value for money. To become cost-effective, it was deemed important for new surgical robotic systems to have added clinical benefit and become less costly than the current system.

Conclusions: This paper and its assisting interactive tool can be used by clinicians, researchers, and policymakers to gain insight in the benefit needed to provide value for money when using a (new) surgical robotic system or, when the effects are known or can be estimated, to assess the value for money for a specific indication. For robotic surgery to provide most value for money, we recommend assessing for each indication whether the necessary effects seem achievable.

Keywords: health care costs; health technology; robotic surgical procedures.