| アブストラクト | OBJECTIVES: Since 2022, transoral robotic surgery (TORS) for pharyngeal and laryngeal cancers has been covered under Japan's national health insurance system. Despite its technical advantages, such as improved access and functional preservation, its adoption remains limited. One of the barriers may be that TORS is reimbursed at the same level as conventional endoscopic surgery, despite requiring substantial initial investment and operational costs. This raises concerns about the underutilization of a potentially valuable technology. Therefore, an economic evaluation of TORS is warranted to inform reimbursement policy. METHODS: We used data from Japan's national Diagnosis Procedure Combination (DPC) database to identify patients with T1-2N0-1M0 pharyngeal or laryngeal cancers who received either TORS or intensity-modulated radiation therapy (IMRT) in 2022. Total medical costs during the treatment period were compared. RESULTS: Among 447 patients identified, 40 received TORS and 407 underwent IMRT. The TORS group had significantly shorter hospital stays (mean 16.3 vs. 55.5 days) and lower mean costs (1.26 vs. 3.45 million yen; P < 0.01) than those who underwent IMRT. Using a generalised linear model with a gamma distribution and log link, and adjusting for sex, age, tumour site, tumour size and nodal status, TORS was associated with significantly lower costs than IMRT (adjusted cost ratio 0.39; 95 % confidence interval 0.35-0.43; P < 0.01). A similar result was observed even when the analysis was limited to patients with oropharyngeal cancer and N0. CONCLUSIONS: TORS demonstrated a significant reduction in medical costs for treating patients with T1-2N0-1M0 pharyngeal or laryngeal cancer. However, this result should be interpreted with caution, as the observed cost advantage is probably due to the current Japanese reimbursement pricing. Nevertheless, the shortened treatment period associated with TORS offers meaningful benefits from the patient perspective. Even with moderate adjustments in reimbursement, the cost-effectiveness of TORS is expected to remain robust. |
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| 組織名 | Department of Healthcare Economics and Quality Management, Graduate School of;Medicine, Kyoto University, Kyoto 606-8501, Japan. Electronic address:;kunisawa.susumu.2v@kyoto-u.ac.jp.;Department of Otolaryngology - Head and Neck Surgery, School of Medicine, Fujita;Health University, Aichi 470-1192, Japan.;Department of Head and Neck Oncology and Innovative Treatment, Graduate School of;Medicine, Kyoto University, Kyoto 606-8507, Japan; Department of;Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto;University, Kyoto 606-8507, Japan.;Department of Health Policy and Informatics, Institute of Science Tokyo Graduate;School of Medical and Dental Sciences, Tokyo 113-8519, Japan.;Medicine, Kyoto University, Kyoto 606-8501, Japan; Department of Health Security;System, Center for Health Security, Graduate School of Medicine, Kyoto;University, Kyoto 606-8501, Japan. |
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