Robot-assisted vs. video-assisted thoracoscopic lobectomy: a systematic review of cost effectiveness

Background: The aim of this study was to systematically review the hospital costs associated with robot-assisted thoracoscopic surgery (RATS) and video-assisted thoracoscopic surgery (VATS) lung lobectomy. Methods: We performed a systematic review of articles comparing the costs of RATS and VATS lobectomy using online databases. Primary outcome was the difference in total hospital stay cost. Secondary outcomes were operating room (OR), OR supply and non-OR costs, as well as OR times, length of hospital stay, rate of conversion to open, complication and mortality rates. Results: Seven articles met inclusion and exclusion criteria. All were retrospective reviews. Data quality and comparability were variable, but RATS lobectomy was consistently more expensive while exhibiting no significant improvement in outcomes compared to VATS. Pooled estimates indicated a reduced complication rate with VATS compared to RATS (odds ratio 0.83, 95% confidence interval: 0.77-0.90, P<0.0001) Mean total cost of RATS was 25.7% greater ($16,645 vs. $13,310). For the subset of studies which further delineated costs, the mean operative costs of RATS were 54.4% higher, while mean non-operative costs were 6.5% lower. Average cost of RATS supplies was 130.3% higher than VATS. Conclusions: Robot-assisted lobectomy is currently not as cost effective when compared to video-assisted thoracoscopic lobectomy. Additionally, there is no evidence that robot-assisted lobectomy will eventually outperform video-assisted alternatives in terms of cost effectiveness. However, there was wide variation in the detail and quality of the data in the studies reviewed, and there is also a need for higher-quality evidence.