Table 3. Scenario Analysis Result of Cost-effectiveness Analysis.
| RARP vs ORP | RARP vs LRP | |||||
|---|---|---|---|---|---|---|
| Incremental | ICER | Incremental | ICER | |||
| Cost, £ (US $) | QALY | Cost, £ (US $) | QALY | |||
| Base case | 526 (693) | 0.12 | 4293 | −1785 (−2350) | 0.24 | RARP dominant |
| Scenarios | ||||||
| Societal perspective | ||||||
| Include non-NHS costs | −7797 (−10 267) | 0.12 | RARP dominant | −22 392 (−29 485) | 0.24 | RARP dominant |
| Lifetime time horizon | 309 (407) | 0.26 | 1190 | −2133 (−2809) | 0.54 | RARP dominant |
| RARP surgical cost change | ||||||
| RARP instruments using new pricea | 248 (327) | 0.12 | 2025 | −2062 (−2715) | 0.24 | RARP dominant |
| RARP surgical system via charity donations | −137 (−180) | 0.12 | RARP dominant | −2447 (−3222) | 0.24 | RARP dominant |
| Annual volume 150 per systemb | 1242 (1635) | 0.12 | 10 140 | −1068 (−1406) | 0.24 | RARP dominant |
| RARP using da Vinci Xi system | 916 (1206) | 0.12 | 7633 | −1395 (−1837) | 0.24 | RARP dominant |
| RARP using da Vinci Si system | 378 (498) | 0.12 | 3150 | −1933 (−2545) | 0.24 | RARP dominant |
| RARP does not reduce risk of BCR (BCR rate same as ORP) | 1444 (1901) | 0.03 | 42 689 | NA | NA | NA |
| New assumptions on LOS: ORP, 3 d; LRP, 2 d; RARP, 2 d | 1056 (1390) | 0.12 | 8619 | −1604 (−2112) | 0.24 | RARP dominant |
Abbreviations: BCR, biochemical recurrence; ICER, incremental cost-effectiveness ratio; LOS, length of stay; LRP, laparoscopic radical prostatectomy; NA, not applicable; NHS, National Health Service; NICE, National Institute for Health and Care Excellence; ORP, open radical prostatectomy; QALY, quality-adjusted life-year; RARP, robotic-assisted radical prostatectomy.
a
New price list for da Vinci surgical instruments is found at Extended Use Program for da Vinci X/Xi Instruments, Intuitive Surgical Inc.24
b
NICE guideline recommends RARP at the centers with annual volume exceeding 150 cases per system.