Discussion
tumor
TUMOR
Our primary economic analysis suggests that iRARC has greater costs per procedure than ORC. There are clear differences in resources used by each surgical approach, with the higher equipment costs of iRARC being partly offset by savings in other ward and critical care costs. This higher cost per patient (£1124 [US $1622]; Our sensitivity analysis highlighted several practical issues. First, reducing robotic surgical times has a large effect on cost-effectiveness. Second, more general changes in the level of health service costs (excluding equipment prices) had relatively small effects due to the counteracting effects of iRARC producing higher theater costs but lower ward costs. However, it should be recognized that these conclusions are based on changes in one cost component at a time. For example, if it is possible to reduce the additional cost of iRARC by £899 (US $1297) per patient by a combination of changes to working practices and/or price, then iRARC becomes cost-effective at a threshold of £20 000 (US $28 860) per QALY gained.Subgroup analyses revealed large changes in cost-effectiveness; iRARC was cost-effective in patients 70 years or older, with tumor stages of T3 or greater, or with a performance status of 1 or above. Our exploratory analysis of these findings suggests that some of these differences are due to younger patients being able to tolerate open surgery better, and so the length of hospital stay and readmission benefits of iRARC are much greater in the older patient group. However, given the post hoc nature of these analyses and the correlations between subgroup membership, we do not believe that it is appropriate to tease apart these differences further.Nonetheless, the subgroup analysis suggests that even if payers consider iRARC not to be cost-effective for all patients within the iROC study, subgroups can be identified for whom iRARC is cost-effective. Other subgroups relating to type of diversion and BMI may also be cost-effective, depending on the funding thresholds adopted by various countries or health plans.