This NIHR HTA funded project aimed to determine the relative clinical effectiveness and cost- effectiveness of robotic radical prostatectomy compared with laparoscopic radical prostatectomy in the treatment of localised prostate cancer. We undertook a systematic review with economic modelling of the effectiveness and safety of the two procedures in the longer term guided by advice from an international panel of experts.

This study demonstrated that robotic prostatectomy had lower perioperative morbidity and a reduced risk of a positive surgical margin compared with laparoscopic prostatectomy although there was considerable uncertainty. Our modelling showed that this excess cost can be reduced if capital costs of equipment are minimised and by maintaining a high case volume for each robotic system of at least 100–150 procedures per year. This finding was primarily driven by a difference in positive margin rate. There is a need for further research to establish how positive margin rates impact on long-term outcomes.


Craig Ramsay;




Ramsay C, Pickard R, Robertson C, Close A, Vale L, Armstrong N, et al. Systematic review and economic modelling of the relative clinical benefit and cost-effectiveness of laparoscopic surgery and robotic surgery for removal of the prostate in men with localised prostate cancer. Health Technol Assess 2012;16(41)

Robertson C, Close A, Fraser C, Gurung T,  Jia X, Sharma P, Vale L, Ramsay C, Pickard R, and the UK Robotic and Laparoscopic Prostatectomy HTA Study Group. Relative effectiveness of robotic and laparoscopic radical prostatectomy for treatment of localized prostate cancer:  A systematic review and mixed treatment comparison meta-analysis. BJUI Volume 112, Issue 6, pages 798–812, October 2013

Close A, Robertson C, Rushton S, Shirley M, Vale L, Ramsay C, Pickard R Comparative Cost-effectiveness of Robot-assisted and Standard Laparoscopic Prostatectomy as Alternatives to Open Radical Prostatectomy for Treatment of Men with Localised Prostate Cancer: A Health Technology Assessment from the Perspective of the UK National Health Service. European Urology, Volume 64, Issue 3, September 2013, Pages 370-371