A Cost-Effectiveness Evaluation of Surgical Approaches to Proctectomy

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

Research output: Contribution to journalArticlepeer-review

1 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
StatePublished - Jun 2021

Bibliographical note

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


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

PubMed: MeSH publication types

  • Journal Article


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