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REINFORCE: A real-world, in-situ, evaluation of the introduction and scale-up of robot-assisted surgical services in the NHS

REINFORCE: A real-world, in-situ, evaluation of the introduction and scale-up of robot-assisted surgical services in the NHS: Evaluating its impact on clinical and service delivery, effectiveness and cost. Stepped-wedge randomised trial with process evaluation and economic evaluation (2022-2025)

Funder: National Institute of Health Research Health Services and Delivery Research (HS&DR) Programme (NIHR131537), £1,397,638.74

Study team: Professor David Beard (University of Oxford), Professor Marion Campbell (University of Aberdeen), Professor Luke Vale (Newcastle University), Professor Graeme MacLennan (University of Aberdeen), Dr Katie Gillies (University of Aberdeen), Professor Jared Torkington (Cardiff and Vale University Health Board), Mr Finbar McGaughey (Patient Representative), Mr Naeem Soomro (Newcastle Upon Tyne Hospitals NHS Foundation Trust), Mr Simon Bach (University of Birmingham), Dr Deena Harji (Newcastle Upon Tyne Hospitals NHS Foundation Trust), Dr Loretta Davies (University of Oxford),Dr Shafaque Shaikh (NHS Grampian), Mr Cameron Matthew (NHS Grampian), Mr John McGrath (Royal Devon and Exeter NHS Foundation Trust), Dr Nawaraj Bhattarai (Newcastle University)

Project overview

Over the next 20 years, robot-assisted surgery (RAS) is expected to increase rapidly around the world, especially for cancer conditions. Previous research shows that when RAS has been introduced in some clinical areas, like urology, it can help surgeons be more precise and can reduce a patient’s hospital stay.

Whilst mostly safe, the majority of the work to date has highlighted continued uncertainty for the effectiveness and usefulness of RAS. More significantly, there has been very little research to date on how RAS impacts wider service delivery. The recommendation stressed the imperative that RAS, like all surgical innovations but especially because of its wider impact on the service, be rigorously evaluated for safety, effectiveness and impact on services before widespread uptake.

This study aims to undertake a real-world, large-scale evaluation of the introduction and scale-up of RAS services evaluating its impact on NHS service delivery, clinical effectiveness, budget and cost-effectiveness. Specific objectives are to provide evidence on the:

  • Impact of RAS system transformation on clinical and service delivery
  • Budget impact and cost-effectiveness to the NHS of the introduction of RAS at scale
  • Potential benefit and harms of RAS across and within specialty areas
  • Mechanisms of change underpinning any change in outcome, including surgeon training

The economic evaluation will comprise a within trial analysis; a system level model (likely a discrete event simulation) of implementation or expansion of use of RAS services at scale, and a budget impact analysis. The purpose of the economic evaluation will not be to derive a single estimate of cost-effectiveness but rather to show how cost-effectiveness might vary according to the context in which surgery is provided (e.g., whether the centre is introducing RAS or extending its use, procurement arrangements, size of centre etc.).

Protocol for the study

The protocol for the REINFORCE study will be published soon. A link to the protocol will be made available here once it is published.

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