Cost and cost-effectiveness of robotic-assisted pyeloplasty compared to laparoscopic pyeloplasty in patients with pelviureteric junction obstruction: a systematic review protocol

Objective: This systematic review will evaluate the costs and cost-effectiveness of robot-assisted pyeloplasty and laparoscopic pyeloplasty in patients with pelviureteric junction obstruction. Introduction: Pelviureteric junction obstruction is the most common congenital abnormality of the urinary tract, affecting approximately 1 in every 1500 live births. Pyeloplasty is the standard treatment, with approaches including open, laparoscopic, and robot-assisted techniques. Though robotics offers advantages such as enhanced precision, concerns remain regarding its cost and cost-effectiveness compared to laparoscopic pyeloplasty, especially in resource-limited settings. Eligibility criteria: The review will include studies involving pediatric and adult patients diagnosed with pelviureteric junction obstruction undergoing robot-assisted pyeloplasty or laparoscopic pyeloplasty. Studies focusing on outcomes related to resource utilization, costs, and cost-effectiveness for robot-assisted pyeloplasty and laparoscopic pyeloplasty, as well as cost analyses with and without comparators, will be included. Methods: The review will follow the JBI guidelines for the systematic review of economic evaluation evidence. A comprehensive search will be conducted among academic and non-academic databases and gray literature. Screening, data extraction, and critical appraisal will be conducted by 2 reviewers with adjudication by a third reviewer. Where feasible, meta-analyses will be performed using incremental net benefit for cost-effectiveness data; otherwise, findings will be presented as a narrative synthesis. JBI’s Dominance Ranking Matrix for economic evaluations will be used to summarize and compare the results of cost-effectiveness studies. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach will be used to assess the certainty of economic evidence for outcomes related to resource use. Review registration: PROSPERO CRD420251036657