Cost-effectiveness of robotic compared with laparoscopic rectal resection. Results from the Spanish prospective national trial ROBOCOSTES.

Objective: The costs related to robotic surgery are known to be greater than those associated with laparoscopy. However, the potential for better outcomes of the former could lead to a cost-effectiveness advantage. The aim of this study is therefore to highlight the difference in cost-effectiveness between robotic and laparoscopic rectal resection.

Methods: This is an observational, multicenter, national prospective study (ROBOCOSTES). From 2022, for 1 year, all consecutive patients undergoing minimally invasive rectal resection were included. Quality-adjusted life year and cost data were prospectively collected. The primary aim was to assess the cost-effectiveness of robotic rectal resection and laparoscopic rectal resection . Secondary aims included clinical outcomes and quality of life.

Results: Overall, 182 patients underwent rectal resection (152 anterior and 30 abdominoperineal excisions) at 14 centers, of whom 95 received robotic rectal resection and 87 laparoscopic rectal resection. Robotic rectal resection was associated with lesser blood loss (58.55 ± 51.68 vs 131.68 ± 191.92, P < .001), lower pain score at day 1 (-1.04 visual analog scale, P < .001) and day 7 (-0.81, P < .001) after surgery, and with fewer hospital readmissions (2.1% vs 15%, P = .005) compared with laparoscopic rectal resection. The overall costs of robotic rectal resection (including hospitalization) were 919.66 euros greater compared with laparoscopic rectal resection, but quality-adjusted life years in the robotic rectal resection group were better than laparoscopic approaches to rectal resection both at 30-day (0.8914 vs 0.8139) and 90-day (0.9573 vs 0.8740) follow-up. At a willingness-to-pay threshold of 20,000 and 30,000 euros, there was an 84.38% and 89.36% probability that robotic rectal resection was more cost-effective than laparoscopic rectal resection.

Conclusion: This study showed that robotic rectal resection, even if associated with greater direct costs in the short term, outperforms laparoscopic rectal resection in terms of quality-adjusted life years and should therefore be preferred where available.