Cost-utility analysis of robot and conventional laparoscopic surgery in the treatment of early-stage endometrial cancer_Chinese Journal of Evidence-Based Medicine

Authors：

ZHANG Min ,  PU Kexue

School of Medical Informatics, Chongqing Medical University, Chongqing 400016, P. R. China;

Corresponding?author：

PU Kexue, Email: pukexue@cqmu.edu.cn

Keywords：

Endometrial cancer; Robot-assisted laparoscopic surgery; Conventional laparoscopic surgery; Cost-utility analysis

DOI：

10.7507/1672-2531.202505120

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To evaluate the cost-effectiveness of robot-assisted laparoscopic surgery (RALS) versus conventional laparoscopic surgery (CLS) for early-stage endometrial cancer (EC) from a societal perspective. Methods A decision-tree model was constructed to conduct cost-utility analysis, simulating the short-term intraoperative to postoperative clinical progression of patients. Primary evaluation metrics included cumulative costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER). The willingness-to-pay (WTP) threshold was set at three times the 2024 per capita gross domestic product (GDP) of China. The sensitivity analyses were performed to assess robustness of the model. Results The base-case analysis revealed that patients in the RALS group gained 0.09 more QALYs at an additional cost of ￥39 079.52 compared with CLS group, the derived ICER was ￥437 157.36/QALYs, exceeding the predefined WTP threshold. The results suggested that RALS does not demonstrate superior cost-effectiveness compared with CLS in the management of early-stage EC. Univariate sensitivity analysis indicated that, when the annual surgical volume per robotic device reaches 809 cases, or the cost of Endowrist consumables per robotic surgery drops below ￥6 568.46, RALS will emerge as a more cost-effective surgical strategy. The probabilistic sensitivity analysis revealed that that RALS becomes more cost-effective when the WTP threshold exceeds ￥402 145.80. Conclusion From a Chinese societal perspective, robotic-assisted laparoscopic surgery for early-stage endometrial cancer is not cost-effective compared with conventional laparoscopic surgery at the current WTP threshold of three times per capita GDP.

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39.	張棟, 徐娟, 宋艷飛, 等. 婦科術后早期炎性腸梗阻19例臨床分析. 中國城鄉企業衛生, 2018, 33(1): 16-18.
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1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2. Crosbie EJ, Kitson SJ, McAlpine JN, et al. Endometrial cancer. Lancet, 2022, 399(10333): 1412-1428.
3. Siegel RL, Miller KD, Wagle NS, et al. Cancer statistics, 2023. CA Cancer J Clin, 2023, 73(1): 17-48.
4. 鄭榮壽, 陳茹, 韓冰峰, 等. 2022年中國惡性腫瘤流行情況分析. 中華腫瘤雜志, 2024, 46(3): 221-231.
5. 中國抗癌協會婦科腫瘤專業委員會. 子宮內膜癌診斷與治療指南(2021年版). 中國癌癥雜志, 2021, 31(6): 501-512.
6. Salehi S, ?vall-Lundqvist E, Legerstam B, et al. Robot-assisted laparoscopy versus laparotomy for infrarenal paraaortic lymphadenectomy in women with high-risk endometrial cancer: a randomised controlled trial. Eur J Cancer, 2017, 79: 81-89.
7. Narducci F, Bogart E, Hebert T, et al. Severe perioperative morbidity after robot-assisted versus conventional laparoscopy in gynecologic oncology: results of the randomized ROBOGYN-1004 trial. Gynecol Oncol, 2020, 158(2): 382-389.
8. Leitao MM, Kreaden US, Laudone V, et al. The RECOURSE study: long-term oncologic outcomes associated with robotically assisted minimally invasive procedures for endometrial, cervical, colorectal, lung, or prostate cancer: a systematic review and meta-analysis. Ann Surg, 2023, 277(3): 387-396.
9. 王楠, 孟元光. 達芬奇機器人手術系統在子宮內膜癌手術中的應用. 中國微創外科雜志, 2016, 16(10): 936-938, 949.
10. Lundin ES, Carlsson P, Wodlin NB, et al. Cost-effectiveness of robotic hysterectomy versus abdominal hysterectomy in early endometrial cancer. Int J Gynecol Cancer, 2020, 30(11): 1719-1725.
11. McCarthy A, Samarakoon D, Gray J, et al. Robotic and laparoscopic gynaecological surgery: a prospective multicentre observational cohort study and economic evaluation in England. BMJ Open, 2023, 13(9): e073990.
12. 楊永顏, 丘麗玉, 李妮, 等. 達芬奇機器人與傳統腹腔鏡手術治療子宮內膜癌圍手術期療效及隨訪情況分析. 中國科技期刊數據庫醫藥, 2024, (12): 52-56.
13. 黃春香. 達芬奇機器人在超重肥胖患者婦科手術中的應用及療效分析. 贛州: 贛南醫學院, 2023.
14. 張晶, 吉中磊, 李明月, 等. 達芬奇機器人手術系統在子宮內膜癌全面分期手術中的應用價值分析. 現代診斷與治療, 2023, 34(6): 907-909.
15. 常淑珍, 張威, 彭鱗鈺, 等. 達芬奇機器人手術操作系統輔助子宮內膜癌全面分期手術在高齡患者中的應用. 腫瘤基礎與臨床, 2022, 35(2): 127-131.
16. 汪麗, 毛燕. 達芬奇機器人手術系統在子宮內膜癌全面分期術中的應用. 世界復合醫學, 2022, 8(2): 72-75.
17. 韓亮亮. 機器人與常規腹腔鏡手術治療子宮內膜癌療效比較. 蘭州: 甘肅中醫藥大學, 2020.
18. 劉國恩, 胡善聯, 吳久鴻, 等. 中國藥物經濟學評價指南2020(中英雙語版). 北京: 中國市場出版社, 2020.
19. Patel S, Lindenberg M, Rovers MM, et al. Understanding the costs of surgery: a bottom-up cost analysis of both a hybrid operating room and conventional operating room. Int J Health Policy Manag, 2022, 11(3): 299-307.
20. 馬春艷. 腹腔鏡手術與開腹手術治療早期子宮內膜癌患者的臨床療效對比分析. 銀川: 寧夏醫科大學, 2023.
21. 黃鳳. 早期子宮內膜癌治療中腹腔鏡與開腹手術的療效比較研究. 湖北民族大學學報(醫學版), 2022, 39(2): 90-91.
22. 代娟. 腹腔鏡與開腹手術治療早期子宮內膜癌的臨床療效分析. 遵義: 遵義醫科大學, 2021.
23. 譚劍昌. 子宮內膜癌不同手術方式對預后影響的真實世界研究. 南寧: 廣西醫科大學, 2021.
24. 王曉爽. 腹腔鏡手術在早期子宮內膜癌治療中的療效. 中國實用醫藥, 2021, 16(9): 40-42.
25. 張學術. 腹腔鏡手術在早期子宮內膜癌治療中的療效觀察. 健康女性, 2021, (3): 10.
26. 宋娟, 段永建, 嚴斌. 腹腔鏡手術與傳統開腹手術治療早期子宮內膜癌的臨床療效比較. 癌癥進展, 2020, 18(21): 2249-2251, 2264.
27. 徐麗媛. 腹腔鏡與開腹手術治療早期子宮內膜癌的對比研究. 蘭州: 蘭州大學, 2020.
28. 劉迎春, 范文生, 李立安, 等. 達芬奇機器人手術與腹腔鏡手術在子宮內膜癌治療中的應用比較. 山東醫藥, 2020, 60(11): 71-73.
29. Ferguson SE, Panzarella T, Lau S, et al. Prospective cohort study comparing quality of life and sexual health outcomes between women undergoing robotic, laparoscopic and open surgery for endometrial cancer. Gynecol Oncol, 2018, 149(3): 476-483.
30. Bell S, Orellana T, Garrett A, et al. Prophylactic anticoagulation after minimally invasive hysterectomy for endometrial cancer: a cost-effectiveness analysis. Int J Gynecol Cancer, 2023, 33(12): 1875-1881.
31. Grabe-Heyne K, Henne C, Odeyemi I, et al. Evaluating the cost-utility of intravesical Bacillus Calmette-Guérin versus radical cystectomy in patients with high-risk non-muscle-invasive bladder cancer in the UK. J Med Econ, 2023, 26(1): 411-421.
32. Walker AR, Leite S, Chen YS, et al. Sentinel lymph node biopsy at the time of hysterectomy for early-stage cervical cancer: a cost-effectiveness analysis. Gynecol Oncol, 2025, 195: 1-5.
33. Walker A, Doyle S, Posnett J, et al. Cost-effectiveness of single-dose tamsulosin and dutasteride combination therapy compared with tamsulosin monotherapy in patients with benign prostatic hyperplasia in the UK. BJU Int, 2013, 112(5): 638-646.
34. Chen D, Kang P, Tao S, et al. Cost-effectiveness evaluation of robotic-assisted thoracoscopic surgery versus open thoracotomy and video-assisted thoracoscopic surgery for operable non-small cell lung cancer. Lung Cancer, 2021, 153: 99-107.
35. Tax C, Govaert PHM, Stommel MWJ, et al. The value of decision analytical modeling in surgical research: an example of laparoscopic versus open distal pancreatectomy. Ann Surg, 2019, 269(3): 530-536.
36. Gosselin-Tardif A, Abou-Khalil M, Mata J, et al. Laparoscopic versus open subtotal gastrectomy for gastric adenocarcinoma: cost-effectiveness analysis. BJS Open, 2020, 4(5): 830-839.
37. Simianu VV, Gaertner WB, Kuntz K, et al. Cost-effectiveness evaluation of laparoscopic versus robotic minimally invasive colectomy. Ann Surg, 2020, 272(2): 334-341.
38. 劉秀, 陳躍鑫, 曾嶸, 等. 利伐沙班與華法林治療下肢深靜脈血栓的臨床效果對比. 中華普通外科雜志, 2017, 32(6): 512-515.
39. 張棟, 徐娟, 宋艷飛, 等. 婦科術后早期炎性腸梗阻19例臨床分析. 中國城鄉企業衛生, 2018, 33(1): 16-18.
40. 張太升. 奧曲肽與腸外營養聯合治療腸梗阻的有效性及對患者胃腸減壓量的影響. 當代醫藥論叢, 2024, 22(19): 25-28.
41. 陽艷. 左氧氟沙星聯合甲硝唑對婦科患者腹腔鏡術后預防切口感染的效果研究. 實用婦科內分泌電子雜志, 2022, 9(4): 106-109.
42. 中國醫師協會微無創醫學專業委員會, 中國婦幼保健協會放射介入專業委員會. 婦科惡性腫瘤盆腔淋巴結切除術后淋巴囊腫診治專家共識(2020年版). 中國實用婦科與產科雜志, 2020, 36(10): 959-964.
43. 周慧敏, 李艷, 胡文莉. 熱敏灸及針灸聯合新斯的明治療陰式全子宮切除術后并發尿潴留的臨床研究. 現代診斷與治療, 2025, 36(3): 339-341, 344.
44. Yoon JH, Yun CY, Choi S, et al. Is robotic surgery beneficial for the treatment of endometrial cancer. A comparison with conventional laparoscopic surgery. J Cancer, 2024, 15(2): 533-538.
45. Barnett JC, Judd JP, Wu JM, et al. Cost comparison among robotic, laparoscopic, and open hysterectomy for endometrial cancer. Obstet Gynecol, 2010, 116(3): 685-693.
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