Economic evaluation of robot-assisted radical prostatectomy compared to open radical prostatectomy for prostate cancer treatment in Ontario, Canada


  • Anna Parackal McMaster University
  • Jean-Eric Tarride McMaster University
  • Feng Xie McMaster University
  • Gord Blackhouse McMaster University
  • Jen Hoogenes McMaster University
  • Danielle Hylton McMaster University
  • Wael Hanna McMaster University
  • Anthony Adili McMaster University
  • Edward D. Matsumoto McMaster University
  • Bobby Shayegan McMaster University



prostate cancer; robot-assisted radical prostatectomy; cost-effectiveness analysis; cost-utility analysis; health technology assessment; surgical technique; Canada


Introduction: Recent health technology assessments (HTAs) of robot-assisted radical prostatectomy (RARP) in Ontario and Alberta, Canada, resulted in opposite recommendations, calling into question whether benefits of RARP offset the upfront investment. Therefore, the study objectives were to conduct a cost-utility analysis from a Canadian public payer perspective to determine the cost-effectiveness of RARP.

Methods: Using a 10-year time horizon, a five-state Markov model was developed to compare RARP to open radical prostatectomy (ORP). Clinical parameters were derived from Canadian observational studies and a recently published systematic review. Costs, resource utilization, and utility values from recent Canadian sources were used to populate the model. Results were presented in terms of increment costs per quality-adjusted life years (QALYs) gained. A probabilistic analysis was conducted, and uncertainty was represented using cost-effectiveness acceptability curves (CEACs). Oneway sensitivity analyses were also conducted. Future costs and QALYs were discounted at 1.5%.

Results: Total cost of RARP and ORP were $47 033 and $45 332, respectively. Total estimated QALYs were 7.2047 and 7.1385 for RARP and ORP, respectively. The estimated incremental cost-utility ratio (ICUR) was $25 704 in the base-case analysis. At a willingness-to-pay threshold of $50 000 and $100 000 per QALY gained, the probability of RARP being cost-effective was 0.65 and 0.85, respectively. The model was most sensitive to the time horizon.

Conclusions: The results of this analysis suggest that RARP is likely to be cost-effective in this Canadian patient population. The results are consistent with Alberta’s HTA recommendation and other economic evaluations, but challenges Ontario’s reimbursement decision.


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How to Cite

Parackal, A., Tarride, J.-E., Xie, F., Blackhouse, G., Hoogenes, J., Hylton, D., Hanna, W., Adili, A., Matsumoto, E. D. ., & Shayegan, B. (2020). Economic evaluation of robot-assisted radical prostatectomy compared to open radical prostatectomy for prostate cancer treatment in Ontario, Canada. Canadian Urological Association Journal, 14(8), E250–7.



Original Research