Economic reporting and conflicts of interest in randomized trials comparing robot-assisted with laparoscopic colorectal surgery: A metaepidemiological systematic review.

Abstract

Robot-assisted colorectal surgery carries a substantial cost premium, yet how consistently randomized trials of these platforms report economic outcomes-and whether reporting relates to industry funding or conflicts of interest-is unclear. We conducted a metaepidemiological systematic review (PROSPERO: CRD420261411610), searching PubMed, Embase, and Cochrane CENTRAL for randomized controlled trials comparing robot-assisted with conventional laparoscopic colorectal surgery. Reports were classified by cost-reporting tier (tier 1, none; tier 2, cost data without a formal economic evaluation; and tier 3, formal economic evaluation with an incremental cost-effectiveness ratio or quality-adjusted life-years); registries and protocols were checked for prespecified economic outcomes. The trial was the primary unit; proportions were estimated with exact 95% confidence intervals, and funding-reporting relationships were described. Twenty-three reports of 15 trials were included. Any cost data were reported by 7 of 15 trials (46.7%; 95% confidence interval, 21.3-73.4) and a formal economic evaluation by 2 of 15 (13.3%); neither cited the Consolidated Health Economic Evaluation Reporting Standards. Four trials had a registered or protocol-documented economic outcome (2 reported, 2 deferred); most reporting no cost had not planned one. Robotic surgery was costlier in every trial reporting cost, although the scope and evidentiary strength of these comparisons varied substantially; the 2 formal evaluations reached opposite conclusions. Two trials were manufacturer funded, and 4 trials had author conflicts of interest; associations were too imprecise for inference. Within these platform trials, economic outcomes were reported inconsistently. When an economic evaluation is intended, prespecifying a cost outcome and following a standard such as Consolidated Health Economic Evaluation Reporting Standards would improve its usefulness for decision-makers.