Custo-efetividade de cirurgia robótica de adenocarcinoma na saúde suplementar

Abstract

Objective: To perform a cost-effectiveness analysis of robotic surgery in the Private
Healthcare system for patients with colorectal adenocarcinoma, aged >18 years, of both

genders, undergoing radical surgical treatment. This study compared the costs and outcomes
in terms of hospital stay and 3-year mortality with laparoscopic surgery. This study aimed to
determine whether robotic surgery is more cost-effective. Method: Systematic review of
health technology assessment, a comprehensive economic cost-effectiveness analysis, based
on the Medline (PubMed) and BIREME databases. 48 articles were found, 24 of which were
utilized after inclusion/exclusion criteria. The model compared the robotic surgical treatment
for colorectal adenocarcinoma with videolaparoscopic surgery. The base case was
laparoscopic surgery and the alternative scenario was robotic surgery. A Markov Chain
mathematical model was proposed, with dynamic transitional models and 36 cycles of 30
days, predicting five possible transitional health states. Uncertainties were addressed through
sensitivity analysis, considering a hypothetical 10,000 patients cohort in the decision tree. In
the sensitivity analysis, only parametric uncertainty was addressed, using second-order Monte
Carlo simulations. Net monetary benefit was calculated with TreeAge® software, as
deterministic/ probabilistic sensitivity analyses and graphs. Results: Costwise as transition
probabilities in the Markov model, suggest that robotic surgery, with a cost per years of life
gained (AVG) of R$ 10,953.99, was the most cost-effective treatment option, absolutely
dominating laparoscopic surgery. The use of laparoscopic surgery, in relation to robotic
surgery, resulted in an increased cost per AVG of R$ 3,796.90. Conclusion: The proposed
analytical model suggests that robotic technology can be a cost-effective option depending
on the willingness to pay.
Descriptors: Cancer; Robotic Surgery; Supplementary Health; Cost-effectiveness;
Laparoscopic Surgery.