1
COST-EFFECTIVENESS OF ROBOT-ASSISTED PARTIAL NEPHRECTOMY FOR THE PREVENTION
OF PERIOPERATIVE COMPLICATIONS
Stephan Buse, MD;a,b Carolin E. Hach, MD;a Phillip Klumpen, MD;a Assen Alexandrov, MDa
Rene Mager, MDb; Alexandre Mottrie, professor;c Axel Haferkamp, professor;b
a
Department of Urology and Urologic Oncology, Alfried Krupp Krankenhaus, Essen, Germany
b
Department of Urology and Pediatric Urology, University Hospital of Frankfurt, Frankfurt,
Germany
c
OLV Vattikuti Robotic Surgery Institute, OLV Hospital Aalst, Aalst, Belgium; Department of
Urology, OLV Hospital Aalst, Aalst, Belgium
Corresponding author:
Stephan Buse
Department of Urology
Alfried Krupp Hospital
Essen, Germany
Phone:0049 201 805 11 33
Fax: 0049 201 805 11 31
stephan.buse@krupp-krankenhaus.de
2
SUPPLEMENTARY MATERIALS
Supplementary Table 1. Model inputs, their distribution, and data sources.
Point
Source
Health States
estimate
α/β
Distribution
Intraoperative Complications
OPN
0.0526 1338/24123
beta
Inhospital Death OPN
0.0029
beta
Respiratory Complications OPN
0.0537 1367/24094
beta
Digestive Complications OPN
0.0991 2522/22939
beta
0.0584 1488/23973
beta
73/25388
Genitourinary Complications
OPN
Ghani, J Urol 20144
Cardiac Complications OPN
0.0348
886/24575
beta
Vascular Complications OPN
0.0172
438/25023
beta
OPN
0.0094
239/2522
beta
Wound Complications OPN
0.0350
892/24569
beta
Infections OPN
0.0147
374/25087
beta
Other Complications OPN
0.1219 3104/22357
beta
Neurological Complications
OR
95%CI
OR Intraoperative
Ghani, J Urol 2014
Complications RAPN
0.69
0.52-0.93
normal*
Ghani, J Urol
OR Inhospital Death RAPN
0.68
0.8-5.33
normal*
2014**
3
OR Respiratory Complications
RAPN
0.6
0.44-0.82
normal*
0.65
0.52-0.81
normal*
OR Digestive Complications
RAPN
OR Genitourinary Complications
Ghani, J Urol 2014
RAPN
0.56
0.42-0.75
normal*
OR Cardiac Complications RAPN
1.17
0.87-1.57
normal*
0.54
0.32-0.92
normal*
OR Vascular Complications
RAPN
OR Neurological Complications
Ghani, J Urol
0.59
0.43-0.81
normal*
RAPN
2014;***
OR Wound Complications RAPN
0.83
0.59-1.16
normal*
OR Infections RAPN
0.14
0.05-0.4
normal*
OR Other Complications RAPN
0.61
0.5-0.75
normal*
Complications LPN
0.67
0.44-1.03
normal*
OR Inhospital Death LPN
0.68
0.08-5.33
normal*
OR Intraoperative
OR Respiratory Complications
Ghani, J Urol 2014
LPN
0.77
0.5-1.18
normal*
OR Digestive Complications LPN
0.83
0.62-1.11
normal*
LPN
0.82
0.56-1.19
normal*
OR Cardiac Complications LPN
0.79
0.48-1.31
normal*
OR Vascular Complications LPN
0.5
0.22-1.16
normal*
OR Genitourinary Complications
4
OR Neurological Complications
Ghani, J Urol
1.7
1.25-2.31
normal*
LPN
2014;***
OR Wound Complications LPN
0.88
0.53-1.43
normal*
OR Infections LPN
0.3
0.09-0.96
normal*
OR Other Complications LPN
0.57
0.42-0.77
normal*
Cost
Median
SE
Cost OR and Supply RAPN
$5'942
123
gamma
Cost Room and Board RAPN
$1'295
27
gamma
Cost Anesthesia RAPN
$561
11.62
gamma
Cost Pharmacy RAPN
$389
8.06
gamma
Cost Lab and Pathology RAPN
$170
3.51
gamma
Cost Professional Fees RAPN
$3'301
68.31
gamma
Ghani, J Urol 2014
Laydner Urology
Cost Blood Bank RAPN
$0
0-4,538
triangular
Cost OR and Supply LPN
$4'211
95.20
gamma
Cost Room and Board LPN
$1'504
34.01
gamma
Cost Anesthesia LPN
$567
12.82
gamma
Cost Pharmacy LPN
$400
9.03
gamma
Cost Lab and Pathology LPN
$171
3.86
gamma
Cost Professional Fees LPN
$3'677
83.14
gamma
2013;8 CPI 1.116
5
Cost Blood Bank LPN
$0
0-752
triangular
Cost OR and Supply OPN
$3'602
289.32
gamma
Cost Room and Board OPN
$2'158
173.34
gamma
Cost Anesthesia OPN
$609
48.94
gamma
Cost Pharmacy OPN
$407
32.71
gamma
Cost Lab and Pathology OPN
$331
26.62
gamma
Cost Professional Fees OPN
$3'983
319.89
gamma
$0
0-4,371
triangular
Cost Blood Bank OPN
*normal distribution of logarithms of OR; ** assumption of same OR for RAPN as reported
for LPN; *** adjusted OR not reported, therefore crude OR calculated from original data; CI:
confidence interval; CPI: consumer price index; LPN: laparoscopic partial nephrectomy; OPN:
open partial nephrectomy; OR: odds ratio; RAPN: robot-assisted partial nephrectomy; SE
standard error
6
Supplementary Fig. 1 Incremental cost-effectiveness plan of RAPN and LPN compared to
OPN for postoperative complications. Each point corresponds to a Monte Carlo simulation’s
iteration result
7
Supplementary Fig. 2 Cost-effectiveness acceptability curve of RAPN and LPN compared to
OPN for postoperative complications
8
Supplementary Fig. 3 One-way sensitivity analysis (incremental cost effectiveness ratio for
RAPN vs OPN) for increasing cost handicaps associated with intraoperative and
postoperative complications