Robot-assisted myomectomy versus open surgery: Cost-effectiveness analysis

Introduction: Fibroids are the most common benign uterine tumors. There are different possibilities for surgical approaches, and evaluating the cost of these operations is fundamental in modern surgery. The aim of our study is to evaluate the cost-effectiveness of robotic-assisted myomectomy (RAM) compared to open myomectomy (OM) in France. Materials and methods: This is an original, retrospective cost analysis and cost-effectiveness comparison between RAM and OM. Women aged >18 years who had undergone myomectomy for large (>8 cm) or multiple (3-5) fibroids via RAM or OM were included from three French hospitals. Confounding factors were controlled using inverse probability of treatment weighting. Costs and major operative complications were assessed one month post-surgery for both groups. The cost per major operative complication (defined as intraoperative and/or postoperative transfusions and/or intraoperative blood loss >500 mL) averted was calculated. The incremental cost-effectiveness ratio was determined by dividing the difference in costs by the difference in complications. Uncertainty was explored through probabilistic and deterministic sensitivity analyses. Other complications were also compared between the two groups. Results: 33 womens were operate by RAM and 66 by OM. A statistically non-significant reduction in intraoperative and/or postoperative transfusions and/or intraoperative blood loss > 500 mL will be in favor of RAM 36.19 % RAM vs. 38.48 % OM; p = 0.85), with a difference of 2.29 % [95 % CI:27.06 % to 16.58 %]. RAM was more expensive than OM, with an additional cost of <euro>3,555 (P < 0.01). The incremental cost-effectiveness ratio at one month was <euro>155,241 per patient without complications. The intervention was 120 min shorter for OM (157) than RAM (277) (p < 0,01). Readmissions were lower on RAM (0 %) vs. OM (1,21 %) (p < 0,01) and the mean on length of stay was lower on RAM (2,90 days) vs. OM (4,34 days) (p < 0,01). Conclusions: RAM reduced the length of hospitalization without increasing the risk of intraoperative complica- tions compared to OM, making it a viable alternative. However, the economic evaluation within our hospitals did not favor RAM. Prospective studies with optimized RAM procedures are needed to confirm these results.