A health technology assessment of robot-assisted keyhole surgery has concluded that while the benefits to patients in certain surgical procedures are evident, the cost of its introduction would be significant.

Published today by the Health Information and Quality Authority, the Health Technology Assessment of robot-assisted surgery in selected surgical procedures examined the evidence of the effectiveness, safety, costs and budget impact of robot-assisted surgery for a number of procedures.

Martin Flattery, Head of HTA Research and Planning at HIQA, said “The Authority’s advice to the HSE is that robot-assisted surgery is superior to conventional open surgery for prostate surgery procedures across a range of outcomes, and is associated with better operative outcomes in conventional open hysterectomy procedures. Compared to conventional laparascopic surgery generally, robot assistance is likely to be associated with less repetitive strain for surgeons, but the clinical benefits for patients would be marginal".

There are however, significant issues to be considered by the HSE prior to the introduction of a new programme of robot-assisted surgery.

The predicted additional costs in the report are based on a single robot being used for a relatively large number of these surgeries. The HSE must consider whether a single hospital could be able to achieve these levels.

The incremental budget impact over five years for introducing a single robot in the publicly funded system is predicted at €3.1 million to €4.5 million for prostate surgery and for hysterectomy procedures, respectively.

“A decision to invest further in a programme of robot-assisted surgery in Ireland will have a significant incremental cost per procedure and a significant budget impact. These costs must be taken into account by the decision maker.” Mr Flattery said.

This HTA assessed the available evidence for robot-assissted surgery for a range of other surgical procedures, but summarised that there is currently insufficient evidence to allow firm conclusions to be made regarding any added benefit with this technology. The report further examined ethical issues that may be associated with a decision to adopt, or not to adopt, the system in Ireland.

“Healthcare budgets are finite and the allocation of resources to this technology may conflict with other values or priorities of decision making, such as the need to benefit the wider community,” Mr Flattery concluded.

In January 2011, HIQA agreed to undertake the HTA of robot-assisted surgery in response to a request from the Health Service Executive. The purpose was to evaluate the available evidence on the safety and efficacy of robot-assisted surgery for selected indications and consider the costs and cost-effectiveness of a policy of implementing it, prior to a decision being taken on the adoption of such technology by the HSE.

The report has been submitted to the HSE and the Minister for Health for their consideration.

Ends

Further Information: 

Marty Whelan, Head of Communications and Stakeholder Engagement
01 814 7481 / 086 2447 623
mwhelan@hiqa.ie

Notes to the Editor: 

• Robot-assisted surgery is an advanced method of keyhole surgery, which is also known as minimally invasive surgery or laparoscopic surgery. It involves the use of an advanced surgical tool to perform minimally invasive surgery for certain procedures. Unlike traditional open surgery, which requires a long incision through the skin, tissue or muscle of the patient, minimally invasive procedures are done using a small number of short incisions.
• Such devices include up to four robotic arms equipped with surgical instruments, which are controlled by the surgeon from an operating console a short distance from the patient. The robotic system provides enlarged and 3D views of the surgical area.
• Prostatectomy and hysterectomy are the only procedures for which sufficient evidence existed at the time of this HTA to support an economic evaluation of robot-assisted surgery. However, the quality of the evidence to support clinical-effectiveness was poor. This issue should be considered when interpreting the findings of this HTA.
• The Health Information and Quality Authority has a statutory remit to undertake health technology assessments (HTAs) for the Department of Health and the HSE. The Authority advises the Minister for Health and the HSE on the results of these assessments.
• HTA is a form of health research that generates information about the clinical and cost-effectiveness of health interventions (technologies), as well as information on their wider impact. The term ‘technology’ includes drugs, medical equipment, diagnostic techniques, surgical procedures, and public health programmes, for example, cancer screening programmes. This information is for use by the public, service providers and health policy makers.