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Cost-effectiveness comparison of minimally invasive, robotic and open approaches in colorectal surgery: a systematic review and bayesian network meta-analysis of randomized clinical trials

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Abstract

Purpose

This study compares the cost-effectiveness of open, laparoscopic (LAP), laparoscopic-assisted (LAPA), hand-assisted laparoscopic (HAL), and robotic colorectal surgery using a network meta-analysis.

Methods

Randomized clinical trials (RCTs) evaluating the cost-effectiveness of comparing the five different approaches in colorectal surgery were included in a literature search until September 2022. Bayesian network meta-analysis was conducted, and surface under cumulative ranking area (SUCRA) values, odds ratio (OR), and 95% credible intervals (CrIs) were reported for total costs, surgical costs, operating time, length of stay (LOS), and postoperative outcomes. Cluster analysis was performed to examine the similarity and classification of surgical approaches into homogeneous clusters. The cophenetic correlation coefficient (cc) was evaluated to identify the most cost-effective clustering method. The primary outcomes assessed were: costs-morbidity, costs-mortality, and costs-efficacy, measuring total costs against postoperative complications, mortality rate, and LOS, respectively.

Results

22 RCTs with 4239 patients were included. Open surgery had the lowest total costs, surgical costs, and operating time but the longest LOS and most postoperative complications. LOS was significantly decreased in LAP compared to open surgery (OR 0.67, 95% CrI 0.46-0.96). Robotic surgery resulted in the highest total costs, surgical costs, and most extended operative duration but the shortest LOS and lowest mortality. LAPA and robotic surgery were superior in the costs-morbidity analysis. HAL was associated with the worst costs-mortality profile. LAP, LAPA, and HAL were better in terms of costs-efficacy.

Conclusion

Overall, LAP and LAPA are the most cost-effective approaches for colorectal surgery in terms of overall postoperative complications, mortality, and LOS.

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Data availability

The data that support the findings of this study are available on request from the corresponding author.

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Acknowledgements

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Authors and Affiliations

  1. Department of Colorectal Surgery, Singapore General Hospital, Academia, 20 College Road, 169856, Singapore, Singapore

    Aik Yong Chok, Yun Zhao & Emile John Kwong Wei Tan

  2. Group Finance Analytics, Singapore Health Services, Singapore, 168582, Singapore

    Yun Zhao, Ivan En-Howe Tan & Marianne Kit Har Au

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Contributions

Conceptualization: Aik Yong Chok. Methodology: Aik Yong Chok; Yun Zhao. Software: Aik Yong Chok; Yun Zhao. Validation: Aik Yong Chok; Ivan En-Howe Tan; Emile John Kwong Wei Tan. Formal analysis: Yun Zhao. Investigation: Aik Yong Chok. Resources: Ivan En-Howe Tan; Marianne Kit Har Au. Data curation: Ivan En-Howe Tan; Marianne Kit Har Au. Writing – Original Draft: Aik Yong Chok; Yun Zhao; Ivan En-Howe Tan. Writing – Review & Editing: all authors. Visualization: Aik Yong Chok; Yun Zhao. Supervision: Marianne Kit Har Au; Emile John Kwong Wei Tan. Project administration: Aik Yong Chok; Emile John Kwong Wei Tan. All authors have read and approved the final version of the manuscript.

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Correspondence to Emile John Kwong Wei Tan.

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Chok, A.Y., Zhao, Y., Tan, I.EH. et al. Cost-effectiveness comparison of minimally invasive, robotic and open approaches in colorectal surgery: a systematic review and bayesian network meta-analysis of randomized clinical trials. Int J Colorectal Dis 38, 86 (2023). https://doi.org/10.1007/s00384-023-04361-5

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