An economic analysis of robot-assisted radical prostatectomy

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RADICAL ASSISTED BY ROBOTICS Prostatectomy (RARP) was first used in Germany in 20001 and began to be performed in the United States approximately two years later.1 It is now estimated that over 90% of all PR in the United States is done robotically.2 As RARP has established itself as the gold standard for RP over the past two decades, associated with less blood loss, shorter hospital stays, fewer complications and better functional outcomes, l Attention has turned to evaluating the costs of RARP compared to other techniques.

A systematic review from 20143 identified 11 previous studies that analyzed the direct costs of different PR techniques, of which only seven compared the costs associated with different approaches. Minimally invasive PR, including RARP, was found to be more expensive than open retro-pubic PR (RRP) in most studies, primarily due to the costs of surgical supplies and longer time in the room. operation. Among cost comparison studies, costs for minimally invasive PR ranged from $ 5,058 to $ 11,806, while those for RRP ranged from $ 4,075 to $ 6,296. A study found that RARP was not cost effective from an economic and health point of view.

However, a recent economic analysis4 concluded that despite the differences in upfront costs, prostate cancer patients who underwent in-hospital RARP versus open radical prostatectomy (ORP) had similar healthcare costs one year later their exit.

US researchers retrospectively examined data from about 11,500 men aged 18 to 64 with prostate cancer who underwent radical prostatectomy, all identified from a large national insurance database. private from January 2013 to December 2018. All patients were enrolled continuously with medical coverage and prescription drugs from 180 days before to one year after surgery. The costs and utilization of health services were compared between patients who underwent ORP (n = 1604) versus RARP (n = 9853).

The main outcomes assessed one year after discharge were total health care costs, including reimbursement paid by insurers and reimbursable patient costs; health care utilization, including inpatient readmission as well as emergency department (ED) visits, outpatient visits and office visits; and the estimated number of days absent from work due to health care use.

Compared to patients who underwent an ORP, the costs at baseline hospitalization were higher for patients who underwent an ARRP. However, the cumulative costs did not differ between groups at 180 days or at one year. At one year, the use of health care in patients in the RARP group was significantly lower than that in the ORP group, with significantly fewer emergency room visits (–0.09 visits; 95% CI, -0.11 to – 0.07; PP

A 2020 study5 reported that like other robotic cancer surgeries compared to open surgery, RARP was more cost-effective for prostate cancer patients. Among the 5,869 patients who underwent a RARP, the reimbursable costs were reduced by $ 137.75 (adjusted difference) compared to the 1,652 patients who underwent an open prostatectomy. The adjusted total costs were also lower with RARP, with a reduction of $ 3872.62 compared to open prostatectomy.

The role of surgeons and hospitals in RARP costs was highlighted in a 2016 study,6 in which US researchers used a weighted sample of nearly 300,000 men with prostate cancer who received an RARP performed by 667 surgeons between 2003 and 2013 at 197 hospitals nationwide, analyzing the costs 90 days hospital. High and low costs per procedure were defined as above the 90th percentile and below the 10th percentile, respectively.

Each RARP resulted in an average hospital cost of $ 11,878 (2014 US dollar value), ranging from an average of $ 2,837 in the low-cost group to an average of $ 25,906 in the high-cost group. The characteristics of hospitals and surgeons appeared to be responsible for about one-third and one-fifth of the cost of RARP, respectively. The odds of high-cost surgery were lower in high-volume surgeons (OR 0.24) and high-volume hospitals (OR 0.105). Investigators also noted an increased likelihood of low-cost RARP in high-volume hospitals (OR 839).

Despite high initial costs, RARP has long-term benefits in terms of cost-effectiveness and cost-utility that justify its implementation, according to a recent Brazilian report.seven A retrospective analysis of outcomes in 56 patients who underwent RRP and 149 who underwent RRP at a single cancer center in 2013 was used to simulate hypothetical cohorts of 1000 patients for the two groups. The average cost was higher in the RARP group than in the RRP group ($ 24,535.49 vs. $ 12,776.32, respectively), but the total cost was lower ($ 1,373,987 vs. $ 1,903,671.93).

The treatment of the hypothetical cohorts was estimated at $ 19,224,195.90 and $ 10,010,582.35, respectively. Using the incremental cost-effectiveness ratio calculations, the difference between groups was $ 9,213,613.55 and the incremental cost-effectiveness ratio was $ 22,690.83 per quality-adjusted life year (QALY) saved .

The references

  1. Binder J, Kramer W. Robot-assisted laparoscopic radical prostatectomy. Int BJU. 2001; 87: 408-10. doi: 10.1046 / j.1464-410x.2001.00115.x
  2. Arenas-Gallo C, Shoag JF, Hu JC. Optimizing surgical techniques in robot-assisted radical prostatectomy. Urol Clin N Am. 2021; 48: 1-9. doi: 10.1016 / j.ucl.2020.09.002
  3. Bolenz C, Freedland SJ, Hollenbeck BK, et al. Costs of radical prostatectomy for prostate cancer: a systematic review. Eur Urol. 2014; 65: 316-24. doi: 10.1016 / j.eururo.2012.08.059
  4. Okhawere KE, Shih I, Lee S, et al. One-year health care cost and usage comparison of open radical prostatectomy versus robot-assisted radical prostatectomy. JAMA Netw Open. 2021; 4 (3): e212265. doi: 10.1001 / jamanetworkopen.2021.2265
  5. Nabi J, Friedlander DF, Chen X et al. Assessment of Reimbursable Fees for Robotic Cancer Surgery in American Adults. JAMA Netw Open. 2020; 3 (1): e1919185. doi: 10.1001 / jamanet- workopen.2019.19185
  6. Cole AP, Leow JJ, Chang SL, et al. Variation at surgeon and hospital level in robotic-assisted radical prostatectomy costs. J Urol. 2016; 196: 1090-5. doi: 10.1016 / d. juro.2016.04.087
  7. de Oliveira RAR, Guimarães GC, Mourão TC, et al. Cost-effectiveness analysis of robot-assisted radical prostatectomy versus retropubic radical prostatectomy: a single cancer center experience. J Robot Surg. Published online January 8, 2021.doi: 10.1007 / s11701-020-01179-z


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