Authors
Julia E Menso, Caro L Bruna, de Graaf Nine, Anouk M L H Emmen, Mahsoem Ali, Bergthor Björnsson, Ugo Boggi, Olivier R Busch, Annalisa Comandatore, Freek Daams, Giovanni Ferrari, Sebastiaan Festen, Jony van Hilst, Ignace H J T de Hingh, Mathieu D'Hondt, Benedetto Ielpo, Tobias Keck, Bas Groot Koerkamp, Daan J Lips, Misha D P Luyer, J Sven Mieog, Luca Morelli, I Quintus Molenaar, Marco Ramera, Francesco Sucameli, Roeland F de Wilde, Patrick Maisonneuve, Gudrun M W Björnelv, Mohammad Abu Hilal, Marc G Besselink, Åsmund A Fretland, European Consortium on Minimally Invasive Pancreatic Surgery (E-MIPS)
Published in
Annals of surgery. Aug 14, 2026. Epub Aug 14, 2026.
Abstract
Although robot-assisted pancreatoduodenectomy (RPD) enhances patient recovery, it could be associated with higher costs than open pancreatoduodenectomy (OPD), potentially limiting its widespread adoption. High-level evidence comparing costs of RPD and OPD is lacking. This analysis in a randomized trial compared costs and cost-effectiveness between RPD and OPD.
Predefined cost-effectiveness analysis in the international randomized DIPLOMA-2 trial (ISRCTN27483786) comparing RPD and OPD in patients with primary resectable neoplasm in 14 centers in 6 European countries (2022-2023). Primary outcomes were mean total hospital costs (euro) at 6 months postoperatively and cost-effectiveness based on costs per quality-adjusted life year (QALY; incremental cost-utility ratio). Three analyses were performed: (1) costs, (2) QALYs including Health-Related Quality of Life (HR-QoL), and (3) cost-effectiveness with probabilities at various willingness-to-pay (WTP) thresholds.
Overall, 268 patients were included (170 RPD, 98 OPD). No significant difference in total hospital costs was found between RPD and OPD (€30,956 vs. €28,271, P=0.538). The intraoperative costs were €5,491 higher with RPD (€11,906 vs. €6,451, P<0.001), whereas postoperative costs were €2806 lower (€19,051 vs. €21,856, P=0.518). The HR-QoL index scores were comparable at 1 and 3 months, but worse at 6 months with RPD (Δ-0.08 [-0.15 to -0.001]). Consequently, over 6 months a QALY loss was observed with RPD (Δ-0.02 [-0.07 to 0.01]) with a <30% probability of RPD being cost-effective across various WTP thresholds.
This analysis in a randomized trial found no significant differences in costs between RPD and OPD up to 6 months. Nonsignificantly lower QALYs at 6 months with RPD resulted in a <30% probability that RPD is cost-effective compared with OPD within 6 months after surgery in selected patients in high-volume centers.
PMID:
42606345
Bibliographic data and abstract were imported from PubMed on 17 Aug 2026.
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