Cost-effectiveness Analysis of Robotic Versus Open Pancreatoduodenectomy (DIPLOMA-2)

Background: 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. Methods: 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. Results: 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. Conclusion: 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.

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Journal
Annals of Surgery
Published
2026-08-14
DOI
https://doi.org/10.1097/sla.0000000000007188
Primary Topic
Pancreatic and Hepatic Oncology Research
Type
article
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article

Cost-effectiveness Analysis of Robotic Versus Open Pancreatoduodenectomy (DIPLOMA-2)

Roeland F. de Wilde, Daan Lips, Patrick Maisonneuve, Francesco Sucameli et al.
Annals of Surgery
Pancreatic and Hepatic Oncology Research
article

Cost-effectiveness Analysis of Robotic Versus Open Pancreatoduodenectomy (DIPLOMA-2)

Roeland F. de Wilde, Daan Lips, Patrick Maisonneuve, Francesco Sucameli, Luca Morelli, Bas Groot Koerkamp, Mahsoem Ali, Jony van Hilst, J. Sven Mieog, Misha D. P. Luyer, Marco Ramera, Anouk M.L.H. Emmen, Ignace H. J. T. de Hingh, C.L. Bruna, Annalisa Comandatore, J.E. Menso, I. Quintus Molenaar, Giovanni Ferrari, Åsmund A. Fretland, Mathieu D’Hondt, Sebastiaan Festen, de Graaf Nine, Gudrun M.W. Björnelv, Olivier R. Busch, Bergthor Björnsson, Benedetto Ielpo, Freek Daams, Tobias Keck, Marc G. Besselink, Ugo Boggi, Mohammad Abu Hilal
article en

Abstract

Background: 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. Methods: 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. Results: 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. Conclusion: 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.

Annals of Surgery
Linköping University (SE), University of Pisa (IT), University of Jordan (JO), Oslo University Hospital (NO), Radboud University Nijmegen (NL), University of Oslo (NO), Leiden University Medical Center (NL), AZ Groeninge (BE), Catharina Ziekenhuis (NL), Medisch Spectrum Twente (NL), Erasmus MC (NL), University Hospital Southampton NHS Foundation Trust (GB), University Medical Center Utrecht (NL), Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda (IT), Universitäres Kinderwunschzentrum Lübeck (DE), St. Antonius Ziekenhuis (NL), OLVG (NL), Hospital Del Mar (ES), Industrial Development Center (Sweden) (SE), Netherlands Comprehensive Cancer Organisation (NL), Fondazione Poliambulanza Istituto Ospedaliero (IT), Amsterdam University Medical Centers (NL), Linköping University Hospital (SE), Cancer Center Amsterdam (NL), European Institute of Oncology (IT), University of Brescia (IT), Vrije Universiteit Amsterdam (NL), University of Amsterdam (NL), Erasmus University Rotterdam (NL)
Openalex Percentile: Top 12%
Pancreatic and Hepatic Oncology Research
DOIOpen Access PDFOpenAlex
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