PurposeThis study evaluated the comparative clinical effectiveness and cost-effectiveness of robotassisted minimally invasive esophagectomy (RAMIE) versus open esophagectomy (OE) and conventional minimally invasive esophagectomy (MIE) in a nationwide real-world setting. Materials and MethodsA target trial emulation was conducted using the Korean National Health Insurance Service database, including patients who underwent first-time esophagectomy for esophageal cancer between 2010 and 2023, with survival followed through June 2024. Propensity score-matched cohorts were created for RAMIE versus OE (n=1, 713 per group) and RAMIE versus MIE (n=1, 162 per group). Clinical outcomes were compared, and a 5-year semi-Markov model was used to estimate quality-adjusted life-years (QALYs) and costs from a healthcare sector perspective with a 4. 5% annual discount rate. Incremental cost-effectiveness ratios (ICERs), incremental net benefits (INBs), and probabilistic sensitivity analyses were calculated. ResultsRAMIE showed comparable or better short-term outcomes, including lower incidence of transfusion-requiring bleeding risk than OE (23. 6% vs. 32. 5%;relative risk RR, 0. 73; 95% CI, 0. 65-0. 81) and MIE (27. 9% vs. 33. 6%;RR, 0. 88; 95% CI, 0. 77-0. 99). Long-term survival was superior to OE (hazard ratio HR, 0. 80; 95% confidence interval CI, 0. 72-0. 88) and similar to MIE (HR, 0. 93; 95% CI, 0. 82-1. 06). RAMIE yielded higher QALYs (Δ0. 311 vs. OE; Δ0. 126 vs MIE) and lower 5-year costs (12, 372-19, 765 vs. OE; 1, 703-9, 097 vs. MIE), resulting in negative ICERs, positive INBs, and high probabilities of cost-effectiveness in sensitivity analyses.
Park et al. (Fri,) studied this question.
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