Robotic Lobectomy is Cost-Effective and Provides Comparable Health Utility Scores to Video-Assisted Lobectomy

Objective: Determine if robotic-assisted lobectomy (RPL-4) is cost-effective and offers improved patient-reported health utility for patients with early-stage NSCLC when compared to video-assisted lobectomy (VATS-Lobectomy). Summary Background Data: Barriers against the adoption of RPL-4 in publicly-funded healthcare include the paucity of high-quality prospective trials and the perceived high cost of robotic surgery. Methods: Patients were enrolled in a blinded, multi-centered, RCT in Canada, the USA, and France, and were randomized 1:1 to either RPL-4 or VATS-Lobectomy. EQ-5D-5L was administered at baseline and post-operative day 1; weeks 3, 7, 12; and months 6 and 12. Direct and indirect costs were tracked using standard methods. Seemingly Unrelated Regression was applied to estimate the cost effect, adjusting for baseline health utility. Incremental cost effectiveness ratio was generated by 10,000 bootstrap samples with multivariate imputation by chained equations. Results: Of 406 patients screened, 186 were randomized, and 164 analyzed after final eligibility review (RPL-4:n=81; VATS-Lobectomy:n=83). Twelve-month follow-up was completed by 94.51%(155/164) of participants. Median age was 68(60-74). There were no significant differences in body mass index, comorbidity, pulmonary function, smoking status, baseline health utility, or tumor characteristics between arms. The mean 12-week health utility score was 0.85(0.10) for RPL-4 and 0.80(0.19) for VATS-Lobectomy ( P =0.02). Significantly more lymph nodes were sampled [10(8-13) vs 8(5-10); P =0.003] in the RPL-4 arm. The incremental cost/QALY of RPL-4 was $14,925.62(95% CI $6,843.69,$23,007.56) at 12-months. Conclusions: Early results of the RAVAL trial suggest that RPL-4 is cost-effective and associated with comparable short-term patient-reported health utility scores when compared to VATS-Lobectomy.