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Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition) ›› 2023, Vol. 13 ›› Issue (04): 205-214. doi: 10.3877/cma.j.issn.2095-123X.2023.04.003

• Clinical Research • Previous Articles     Next Articles

Efficacy and health economic evaluation of robot-assisted stereotactic hematoma drainage for spontaneous intracerebral hemorrhage

Ke Tan(), Jinping Li, Yutao Peng, Wenqian Wu, Ziwen Yang, Yang Wang, Libo Tao, Chang Liu   

  1. Department of Neurosurgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
    Center for Health Policy and Technology Evaluation, Peking University Health Science Center, Beijing 100083, China
  • Received:2023-05-09 Online:2023-08-15 Published:2023-11-09
  • Contact: Ke Tan
  • Supported by:
    The Innovation Technology Project of Beijing Chao-Yang Hospital, Capital Medical University(22kcjjyb-4)

Abstract:

Objective

To investigate the clinical efficacy and health economic evaluation of hematoma drainage for spontaneous intracerebral hemorrhage (SICH) with the assistance of neurosurgical navigation and positioning planning system (referred to as robot).

Methods

The clinical data and economic data of 199 SICH patients who underwent surgical treatment from March 2019 to March 2022 were collected. All patients were divided into 4 groups according to surgical methods: the robotic surgery group consisted of 77 patients who underwent robot assisted stereotactic hematoma drainage surgery; 65 cases in the neuro-endoscopy groups underwent hematoma removal surgery under neuroendoscopy; 21 cases in the small bone window craniotomy group underwent microscopic hematoma removal with small bone window open; 36 cases in the rigid catheter group underwent CT image-guided free-hand rigid catheter technique. Clinical follow-up outcomes and medical cost from the immediate post-operative to one year period were compared and analyzed. Data from both the robotic surgery and neuro-endoscopy groups were sampled and matched using propensity scoring methods, and health economics were evaluated using modified Rankin scale (mRS) scores and quality adjusted life years (QALYs) indicators.

Results

At the time of discharge, there were differences between the groups in terms of operation time, hematoma residual volume, total hospital costs, surgery-related costs, number of days in the ICU, and duration of ventilator use (P<0.05). In the robotic surgery group complication rate of rebleeding was 2.6%, intracranial infection was 1.3%, average hospital stay was 15.45 d, and average hospital cost was ¥46 077.90. There was difference in the proportion of mRS≤3 points between the 4 groups (P<0.05), in which the proportion of patients with mRS≤3 points at 3 months and 1 year after surgery in the robotic surgery group was 55.8% and 74.0%, respectively. Propensity score sampling was matched, resulting in 37 patients each in the balanced and comparable robotic surgery and neuro-endoscopy groups. One year after surgery, the robotic surgery group was able to save ¥36 862.14 per capita and gain 0.062 more QALYs.

Conclusion

Based on our model of SICH calculations suggest that robotic-assisted stereotactic drainage has the health economic advantage of being less costly and more effective, further results await multicenter, prospective randomized controlled trials with expanded sample size.

Key words: Spontaneous intracerebral hemorrhage, Robotics, Stereotactic neurosurgery, Minimally invasive surgery, Health economic evaluation

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