A Cost-Effectiveness Evaluation of Surgical Approaches to Proctectomy

Vlad V. Simianu, Thomas Curran, Wolfgang B. Gaertner, Bradford Sklow, Karen M. Kuntz, Mary R. Kwaan, Robert D. Madoff, Christine C. Jensen

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Background: Robotic surgery is increasingly used for proctectomy, but the cost-effectiveness of this approach is uncertain. Robotic surgery is considered more expensive than open or laparoscopic approaches, but in certain situations has been demonstrated to be cost-effective. We examined the cost-effectiveness of open, laparoscopic, and robotic approaches to proctectomy from societal and healthcare system perspectives. Methods: We developed a decision-analytic model to evaluate one-year costs and outcomes of robotic, laparoscopic, and open proctectomy based on data from the available literature. The robustness of our results was tested with one-way and multi-way sensitivity analyses. Results: Open proctectomy had increased cost and lower quality of life (QOL) compared with laparoscopy and robotic approaches. In the societal perspective, robotic proctectomy costs $497/case more than laparoscopy, with minimal QOL improvements, resulting in an incremental cost-effectiveness ratio (ICER) of $751,056 per quality-adjusted life year (QALY). In the healthcare sector perspective, robotic proctectomy resulted in $983/case more and an ICER of $1,485,139/QALY. One-way sensitivity analyses demonstrated factors influencing cost-effectiveness primarily pertained to the operative cost and the postoperative length of stay (LOS). In a probabilistic sensitivity analysis, the cost-effective approach to proctectomy was laparoscopic in 42% of cases, robotic in 39%, and open in 19% at a willingness-to-pay (WTP) of $100,000/QALY. Conclusions: Laparoscopic and robotic proctectomy cost less and have higher QALY than the open approach. Based on current data, laparoscopy is the most cost-effective approach. Robotic proctectomy can be cost-effective if modest differences in costs or postoperative LOS can be achieved.

Original languageEnglish (US)
Pages (from-to)1512-1523
Number of pages12
JournalJournal of Gastrointestinal Surgery
Issue number6
Early online dateMay 11 2020
StatePublished - May 11 2020

Bibliographical note

Publisher Copyright:
© 2020, The Society for Surgery of the Alimentary Tract.


  • Cost-effectiveness
  • Laparoscopy
  • Proctectomy
  • Robotics
  • Willingness-to-pay


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