Cost-Effectiveness of Robot-Assisted Partial Nephrectomy for the Prevention of Perioperative

COST-EFFECTIVENESS OF ROBOT-ASSISTED PARTIAL NEPHRECTOMY FOR THE PREVENTION OF PERIOPERATIVE COMPLICATIONS

Stephan Buse, MD;a,bCarolin E. Hach, MD;a Phillip Klumpen, MD;aAssenAlexandrov, MDa Rene Mager, MDb; Alexandre Mottrie, professor;c Axel Haferkamp, professor;b

a Department of Urology and Urologic Oncology, Alfried Krupp Krankenhaus, Essen, Germany

b Department of Urology and Pediatric Urology, University Hospital of Frankfurt, Frankfurt, Germany

c OLV Vattikuti Robotic Surgery Institute, OLV Hospital Aalst, Aalst, Belgium; Department of Urology, OLV Hospital Aalst, Aalst, Belgium

Corresponding author:Stephan Buse

Department of Urology

Alfried Krupp Hospital

Essen, Germany

Phone:0049 201 805 11 33

Fax: 0049 201 805 11 31

SUPPLEMENTARY MATERIALS

SupplementaryTable 1. Model inputs, their distribution, and data sources.

Health States / Point estimate / α/β / Distribution / Source
Intraoperative Complications OPN / 0.0526 / 1338/24123 / beta / Ghani, J Urol 20144
Inhospital Death OPN / 0.0029 / 73/25388 / beta
RespiratoryComplications OPN / 0.0537 / 1367/24094 / beta
Digestive Complications OPN / 0.0991 / 2522/22939 / beta
GenitourinaryComplications OPN / 0.0584 / 1488/23973 / beta
CardiacComplications OPN / 0.0348 / 886/24575 / beta
VascularComplications OPN / 0.0172 / 438/25023 / beta
Neurological Complications OPN / 0.0094 / 239/2522 / beta
WoundComplications OPN / 0.0350 / 892/24569 / beta
Infections OPN / 0.0147 / 374/25087 / beta
Other Complications OPN / 0.1219 / 3104/22357 / beta
OR / 95%CI
OR Intraoperative Complications RAPN / 0.69 / 0.52-0.93 / normal* / Ghani, J Urol 2014
OR Inhospital Death RAPN / 0.68 / 0.8-5.33 / normal* / Ghani, J Urol 2014**
OR RespiratoryComplications RAPN / 0.6 / 0.44-0.82 / normal* / Ghani, J Urol 2014
OR Digestive Complications RAPN / 0.65 / 0.52-0.81 / normal*
OR GenitourinaryComplications RAPN / 0.56 / 0.42-0.75 / normal*
OR CardiacComplications RAPN / 1.17 / 0.87-1.57 / normal*
OR VascularComplications RAPN / 0.54 / 0.32-0.92 / normal*
OR Neurological Complications RAPN / 0.59 / 0.43-0.81 / normal* / Ghani, J Urol 2014;***
OR WoundComplications RAPN / 0.83 / 0.59-1.16 / normal* / Ghani, J Urol 2014
OR Infections RAPN / 0.14 / 0.05-0.4 / normal*
OR Other Complications RAPN / 0.61 / 0.5-0.75 / normal*
OR Intraoperative Complications LPN / 0.67 / 0.44-1.03 / normal*
OR Inhospital Death LPN / 0.68 / 0.08-5.33 / normal*
OR RespiratoryComplications LPN / 0.77 / 0.5-1.18 / normal*
OR Digestive Complications LPN / 0.83 / 0.62-1.11 / normal*
OR GenitourinaryComplications LPN / 0.82 / 0.56-1.19 / normal*
OR CardiacComplications LPN / 0.79 / 0.48-1.31 / normal*
OR VascularComplications LPN / 0.5 / 0.22-1.16 / normal*
OR Neurological Complications LPN / 1.7 / 1.25-2.31 / normal* / Ghani, J Urol 2014;***
OR WoundComplications LPN / 0.88 / 0.53-1.43 / normal* / Ghani, J Urol 2014
OR Infections LPN / 0.3 / 0.09-0.96 / normal*
OR Other Complications LPN / 0.57 / 0.42-0.77 / normal*
Cost / Median / SE
Cost OR and Supply RAPN / $5'942 / 123 / gamma / LaydnerUrology 2013;8 CPI 1.116
Cost Room and Board RAPN / $1'295 / 27 / gamma
CostAnesthesia RAPN / $561 / 11.62 / gamma
CostPharmacy RAPN / $389 / 8.06 / gamma
Cost Lab and Pathology RAPN / $170 / 3.51 / gamma
Cost Professional Fees RAPN / $3'301 / 68.31 / gamma
Cost Blood Bank RAPN / $0 / 0-4,538 / triangular
Cost OR and Supply LPN / $4'211 / 95.20 / gamma
Cost Room and Board LPN / $1'504 / 34.01 / gamma
CostAnesthesia LPN / $567 / 12.82 / gamma
CostPharmacy LPN / $400 / 9.03 / gamma
Cost Lab and Pathology LPN / $171 / 3.86 / gamma
Cost Professional Fees LPN / $3'677 / 83.14 / gamma
Cost Blood Bank LPN / $0 / 0-752 / triangular
Cost OR and Supply OPN / $3'602 / 289.32 / gamma
Cost Room and Board OPN / $2'158 / 173.34 / gamma
CostAnesthesia OPN / $609 / 48.94 / gamma
CostPharmacy OPN / $407 / 32.71 / gamma
Cost Lab and Pathology OPN / $331 / 26.62 / gamma
Cost Professional Fees OPN / $3'983 / 319.89 / gamma
Cost Blood Bank OPN / $0 / 0-4,371 / triangular

*normal distribution of logarithms of OR; ** assumption of same OR for RAPN as reported for LPN; *** adjusted OR not reported, therefore crude OR calculated from original data; CI: confidence interval; CPI: consumer price index; LPN: laparoscopic partial nephrectomy; OPN: open partial nephrectomy; OR: odds ratio; RAPN: robot-assisted partial nephrectomy; SE standard error

Supplementary Fig. 1 Incremental cost-effectiveness plan of RAPN and LPN compared to OPN for postoperative complications. Each point corresponds to a Monte Carlo simulation’s iteration result

Supplementary Fig. 2 Cost-effectiveness acceptability curve of RAPN and LPN compared to OPN for postoperative complications

Supplementary Fig. 3 One-way sensitivity analysis (incremental cost effectiveness ratio for RAPN vs OPN) for increasing cost handicaps associated with intraoperative and postoperative complications