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• RATS harvested an incremental 0.28 QALYs at an additional cost of $3104.82, making for an ICER of $10967.41 per QALY over OT. • Robotic approach was associated with less cost-effective than VATS, making for an ICER of $80324.98 per QALY versus VATS. • The CE probabilities of RATS for 24 of 31 provinces in China were > 0.60 at corresponding WTP thresholds. This study aimed to evaluate the cost-effectiveness of robotic-assisted thoracoscopic surgery (RATS) over open thoracotomy (OT) and video-assisted thoracoscopic surgery (VATS) for operable non-small cell lung cancer (NSCLC) from the perspective of Chinese healthcare payer. The Markov decision model was developed to assess the 5-year costs and quality-adjusted life year (QALY) of RATS versus OT and VATS for operable NSCLC patients. The propensity-matched cohorts were generated from our clinical center to determine the surgical costs and complication rates. An individual patient data meta-analysis was conducted to estimate model probabilities of progression and survival risks. Other model inputs were abstracted from available studies. The primary outcome was incremental cost-effectiveness ratios (ICERs). RATS contributed to an incremental 0.28 QALYs at an additional cost of $3,104.82, making for an ICER of $10,967.41 per QALY versus OT. Robotic approach harvested an incremental 0.05 QALYs at an additional cost of $4006.86, making for an ICER of $80324.98 per QALY over VATS. RATS shown a same cost-effectiveness probability (0.50) versus OT and VATS at a willing-to-pay (WTP) threshold of $12,000 per QALY and $75,800 per QALY, respectively. The probabilities of cost-effectiveness for RATS were 0.64 and 0.21 at a presupposed WTP threshold of $ 30,000 per QALY versus OT and VATS, respectively. RATS was evaluated to be cost-effective versus OT for patients with operable NSCLC from the perspective of Chinese healthcare payer. To the contrary, robotic approach was associated with less cost-effective than VATS. [ABSTRACT FROM AUTHOR]

The video assisted thoracoscopic surgery (VATS) for lobectomy which is newly developed technology represents an important option for lung cancer due to less morbidity and mortality compare with open lobectomy. Although the total hospitalization costs were similar, CNY46,799.70 in VATS lobectomy group vs CNY45,321.98 in open group (P=0.478), the proportion of material cost in VATS was higher (44% vs. 37%, P<0.001). Meanwhile, although the consumable material cost proportion is higher in VATS group, the total hospitalization cost will not increase due to cost-savings in medicine and treatment costs. [Extracted from the article]