Background Among the various causes of death, colorectal carcinoma represents the second highest cause in frequency both in men and in women. A colorectal cancer is diagnosed every 3,5 minutes and a person dies of colorectal cancer every 9 minutes. In 2018, in Italy around 51.000 new cases, with a mortality rate of over 18.000 deaths were recorded. There is clear evidence demonstrating that the identification and treatment of cancer at an early stage positively influence the reduction in mortality. Colonoscopy is the most effective technique used to identify and remove polyps, thus avoiding the costs related to surgical treatment and hospitalization. 

The features of the Endotics® system were designed to overcome three issues associated with conventional colonoscopy: pain, risks (contamination, work-related injuries), and learning curve. At first, the system was only used on complicated patients with previous failed conventional colonoscopy, later the system was used on patients eligible for anaesthesia.

Endotics is a robotic colonoscopy system consisting of a workstation equipped with a control console and a disposable endoscopy probe with microcamera. The locomotion of the probe inside the intestine is based on the "inchworm" principle and is made possible by an anchoring system, positioned at the ends of the flexible body.

The purpose of this study was to evaluate the costs of the Endotics® system for robotic colonoscopy as an alternative to conventional diagnostic colonoscopy performed under anaesthesia from the University Hospital of Pisa perspective.

Methods The cost analysis was developed according to the Budget Impact  Analysis method application, an essential and complementary part of the HTA evaluation, which has the main purpose of assessing the financial sustainability of a new health technology. The direct hospital costs for each step of the two procedures were collected. The observation period covered a time interval of 3 months, during which an average of 43 colonoscopic procedures per day was performed and mapped and a total of 23 colonoscopes were used in the University Hospital of Pisa. 

Results Overall, the work done has allowed identifying the direct cost of a conventional painless diagnostic colonoscopy performed which amounts to € 426.25. The valuation of the direct costs of the robotic colonoscopy amounted overall to € 441.25. The results showed that the two methods were cost equivalent even if the economic advantages of the robotic colonoscopy in terms of lack of anesthesia and post intervention infections should be considered. 

Conclusions The ideal procedure to diagnose a colon disease should be safe, well-tolerated, possibly non-invasive, with high diagnostic accuracy and, not least, cost-effectiveness. The results of this study suggest that in the University Hospital of Pisa the costs related to robotic colonoscopy performed with the Endotics® system are superimposable to those of conventional painless colonoscopy, reducing the overall risk associated with the colonoscopic procedure and maintaining a high diagnostic accuracy with a greater tolerability by the patient.

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Key words: colorectal carcinoma, robotic diagnostic colonoscopy, conventional diagnostic colonoscopy, Budget Impact Analysis