Cost-analysis and quality of life after laparoscopic and robotic ventral mesh rectopexy for posterior compartment prolapse : a randomized trial
|Author:||Mäkelä-Kaikkonen, Johanna1,2; Rautio, Tero Tapani3,4; Ohinmaa, Arto5;|
1Division of Gastroenterology, Department of Surgery, University Hospital of Oulu, PO Box 21, 90029 Oulu, Finland
2Center of Surgical Research, Medical Research Center, University of Oulu, Oulu, Finland
3Division of Gastroenterology, Department of Surgery, University Hospital of Oulu, PO Box 21, 90029 Oulu, Finland
4Center of Surgical Research, Medical Research Center, University of Oulu, Oulu, Finland
5School of Public Health, University of Alberta, Edmonton, AB, Canada
6Department of Obstetrics and Gynecology, University Hospital of Oulu, Oulu, Finland
7Department of Public Health, University of Helsinki, Helsinki, Finland
|Online Access:||PDF Full Text (PDF, 0.9 MB)|
|Persistent link:|| http://urn.fi/urn:nbn:fi-fe2019080523484
|Publish Date:|| 2019-08-05
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.
Techniques in coloproctology
|Pages:||461 - 470|
|Type of Publication:||
A1 Journal article – refereed
|Field of Science:||
3126 Surgery, anesthesiology, intensive care, radiology
Open access funding provided by University of Oulu including Oulu University Hospital. The Gastroenterological Diseases Research Foundation, Finnish Medical Research Foundation.
© The Author(s) 2019. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.