Cost-effectiveness of robotic mastectomy vs. conventional mastectomy: A long-term economic evaluation from a Singapore healthcare perspective.

Abstract

Importance: Breast cancer is the most prevalent cancer among women globally, and Singapore is no exception. Surgical intervention, especially mastectomy, is a cornerstone of breast cancer treatment. While conventional mastectomy (CM) has been the gold standard, robotic mastectomy (RM) has emerged as a promising alternative due to its minimally invasive nature. However, its cost-effectiveness remains uncertain, especially in resource-constrained settings like Singapore.

Objective: To determine whether robotic mastectomy is cost-effective compared to conventional mastectomy in Singapore from a healthcare system perspective, using quality-adjusted life years (QALYs) and the incremental cost-effectiveness ratio (ICER) as outcome measures.

Design setting and participants: This cost-utility analysis used a Markov model to simulate long-term health outcomes and costs associated with RM and CM over a 10-year horizon. Data on surgical costs, quality of life, survival rates, and complication probabilities were drawn from published literature and clinical expert opinion. The analysis was conducted from a Singaporean healthcare perspective, applying a 3 % annual discount rate to account for time preferences.

Interventions: Robotic mastectomy and conventional mastectomy were compared in terms of their associated costs and health outcomes. RM utilized the da Vinci robotic surgical system, while CM was performed via traditional surgical techniques.

Main outcomes and measures: The primary outcome was the incremental cost-effectiveness ratio (ICER) (cost per QALY gained), with QALYs as the measure of effectiveness. Sensitivity analyses (including probabilistic sensitivity analysis (PSA)) assessed the robustness of results to variations in model parameters.

Results: The base-case analysis showed that RM incurred higher upfront costs but resulted in higher long-term QALY gains compared to CM. The ICER for RM was estimated at SGD 30,000 per QALY, below Singapore's willingness-to-pay (WTP) threshold of SGD 65,000 per QALY. Probabilistic sensitivity analysis (PSA) demonstrated that RM remained cost-effective in 85 % of simulations at the WTP threshold. The Cost-Effectiveness Frontier (CEF) analysis confirmed that RM offered better value as the WTP threshold increased.

Conclusion and relevance: Robotic mastectomy is cost-effective in the long term in Singapore, primarily due to fewer complications, faster recovery, and improved quality of life. These findings are relevant for healthcare policymakers seeking to optimize breast cancer treatment in resource-limited settings.