Making a case for high‐volume robotic surgery centers: A cost‐effectiveness analysis of transoral robotic surgery

Objective To evaluate the cost‐effectiveness of transoral robotic surgery (TORS) compared to intensity‐modulated radiotherapy (IMRT) for early stage (T1‐2, N0, M0) oropharyngeal squamous cell carcinoma (OPSCC). Patients and Methods A Markov decision tree model with a 5‐year time horizon was developed. Comparative groups were: i) TORS with concurrent ipsilateral neck dissection +/− adjunctive IMRT, and ii) primary IMRT. Primary outcome was cost/quality adjusted life year (QALY). Perspective was the United States third party payer. Costs and effects were discounted at a rate of 3.5%. A threshold and probabilistic sensitivity analysis were performed. Results TORS strategy cost $30,992 and provided 4.81 QALYs/patient. The IMRT strategy cost $26,033 and provided a total of 4.78 QALYs/patient. The incremental cost effectiveness ratio for TORS vs. IMRT in the reference case was $165,300/QALY. The probability that TORS is cost‐effective compared to IMRT at a maximum willingness‐to‐pay threshold of $50,000/QALY is 42%. Conclusion An IMRT strategy for management of early stage OPSCC is more likely to be cost‐effective compared to TORS. To improve the value of TORS for early stage OPSCC, consolidating TORS procedures to create high‐volume centers of excellence may be a potential strategy to increase incremental effectiveness and reduce incremental costs. J. Surg. Oncol. 2015 111:155–163 . © 2015 Wiley Periodicals, Inc.