Format

Send to

Choose Destination
Tech Coloproctol. 2019 May;23(5):461-470. doi: 10.1007/s10151-019-01991-2. Epub 2019 May 8.

Cost-analysis and quality of life after laparoscopic and robotic ventral mesh rectopexy for posterior compartment prolapse: a randomized trial.

Author information

1
Division of Gastroenterology, Department of Surgery, University Hospital of Oulu, PO Box 21, 90029, Oulu, Finland. johanna.makela-kaikkonen@ppshp.fi.
2
Center of Surgical Research, Medical Research Center, University of Oulu, Oulu, Finland. johanna.makela-kaikkonen@ppshp.fi.
3
Division of Gastroenterology, Department of Surgery, University Hospital of Oulu, PO Box 21, 90029, Oulu, Finland.
4
Center of Surgical Research, Medical Research Center, University of Oulu, Oulu, Finland.
5
School of Public Health, University of Alberta, Edmonton, AB, Canada.
6
Department of Obstetrics and Gynecology, University Hospital of Oulu, Oulu, Finland.
7
Department of Public Health, University of Helsinki, Helsinki, Finland.

Abstract

BACKGROUND:

The aim of this study was to assess, whether robotic-assistance in ventral mesh rectopexy adds benefit to laparoscopy in terms of health-related quality of life (HRQoL), cost-effectiveness and anatomical and functional outcome.

METHODS:

A prospective randomized study was conducted on patients who underwent robot-assisted ventral mesh rectopexy (RVMR) or laparoscopic ventral mesh rectopexy (LVMR) for internal or external rectal prolapse at Oulu University Hospital, Finland, recruited in February-May 2012. The primary outcomes were health care costs from the hospital perspective and HRQoL measured by the 15D-instrument. Secondary outcomes included anatomical outcome assessed by pelvic organ prolapse quantification method and functional outcome by symptom questionnaires at 24 months follow-up.

RESULTS:

There were 30 females (mean age 62.5 years, SD 11.2), 16 in the RVMR group and 14 in the LVMR group. The surgery-related costs of the RVMR were 1.5 times higher than the cost of the LVMR. At 3 months the changes in HRQoL were 'much better' (RVMR) and 'slightly better' (LVMR) but declined in both groups at 2 years (RVMR vs. LVMR, p > 0.05). The cost-effectiveness was poor at 2 years for both techniques, but if the outcomes were assumed to last for 5 years, it improved significantly. The incremental cost-effectiveness ratio for the RVMR compared to LVMR was €39,982/quality-adjusted life years (QALYs) at 2 years and improved to €16,707/QALYs at 5 years. Posterior wall anatomy was restored similarly in both groups. The subjective satisfaction rate was 87% in the RVMR group and 69% in the LVMR group (p = 0.83).

CONCLUSIONS:

Although more expensive than LVMR in the short term, RVMR is cost-effective in long-term. The minimally invasive VMR improves pelvic floor function, sexual function and restores posterior compartment anatomy. The effect on HRQoL is minor, with no differences between techniques.

KEYWORDS:

Cost-analysis; Laparoscopic; Quality of life; Robotic; Ventral mesh rectopexy

Supplemental Content

Full text links

Icon for Springer Icon for PubMed Central
Loading ...
Support Center