A Multidimensional Analysis of Prostate Surgery Costs in the United States: Robotic-Assisted versus Retropubic Radical Prostatectomy

Bijlani, Akash; Slee, April; Davitian, Mike; May, Holly C.; Speers, Mark; Leung, Robert; Mohamed, Nihal; Sacks, Henry S.; Tewari, Ashutosh

doi:10.1016/j.jval.2015.12.019

Cited by 28 publications

(33 citation statements)

References 104 publications

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“…Four studies found a reduced cost for the payer when comparing RARP with RRP. Their results were likely affected by high case volumes for RARP [26], lack of adjustment for patients’ general health status and socioeconomic status [27,28], and assumptions that went into cost modeling [29]. …”

Section: Evidence Synthesismentioning

confidence: 99%

“…While most markups fall into the 1.5–4 range relative to Medicare allowable cost, the markup may be more than 10 times that cost [34]. Finally, three studies constructed models to estimate cost, based on data from the literature and reimbursement rates [29,35,36]. Two of these studies did not perform sensitivity analyses to test how the assumptions would affect cost from the payer’s perspective [29,36].…”

Section: Evidence Synthesismentioning

confidence: 99%

“…One study found a shortened sick leave after RARP compared with RRP, but did not estimate the economic impact of that difference [32]. Finally, a comprehensive study found that RARP saved approximately $1200 per case due to faster recovery and fewer lost wages [29]. This study used a systematic review of the literature to estimate model inputs and constructed detailed care pathways and cost models, but there is a high risk of conflict of interest because it was conducted and funded by Intuitive Surgical, the manufacturer of the surgical robot [29].…”

Section: Evidence Synthesismentioning

confidence: 99%

“…Finally, a comprehensive study found that RARP saved approximately $1200 per case due to faster recovery and fewer lost wages [29]. This study used a systematic review of the literature to estimate model inputs and constructed detailed care pathways and cost models, but there is a high risk of conflict of interest because it was conducted and funded by Intuitive Surgical, the manufacturer of the surgical robot [29]. Nevertheless, it is reasonable to conclude that RARP at least has the potential for a moderate cost advantage from the societal perspective if optimal outcomes are achieved, allowing patients to return to work more quickly.…”

Section: Evidence Synthesismentioning

confidence: 99%

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Cost of New Technologies in Prostate Cancer Treatment: Systematic Review of Costs and Cost Effectiveness of Robotic-assisted Laparoscopic Prostatectomy, Intensity-modulated Radiotherapy, and Proton Beam Therapy

et al. 2017

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Context Some of the high costs of robot-assisted radical prostatectomy (RARP), intensity-modulated radiotherapy (IMRT), and proton beam therapy may be offset by better outcomes or less resource use during the treatment episode. Objective To systematically review the literature to identify the key economic trade-offs implicit in a particular treatment choice for prostate cancer. Evidence acquisition We systematically reviewed the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement and protocol. We searched Medline, Embase, and Web of Science for articles published between January 2001 and July 2016, which compared the treatment costs of RARP, IMRT, or proton beam therapy to the standard treatment. We identified 37, nine, and three studies, respectively. Evidence synthesis RARP is costlier than radical retropubic prostatectomy for hospitals and payers. However, RARP has the potential for a moderate cost advantage for payers and society over a longer time horizon when optimal cancer and quality-of-life outcomes are achieved. IMRT is more expensive from a payer’s perspective compared with three-dimensional conformal radiotherapy, but also more cost effective when defined by an incremental cost effectiveness ratio <$50 000 per quality-adjusted life year. Proton beam therapy is costlier than IMRT and its cost effectiveness remains unclear given the limited comparative data on outcomes. Using the Grades of Recommendation, Assessment, Development and Evaluation approach, the quality of evidence was low for RARP and IMRT, and very low for proton beam therapy. Conclusions Treatment with new versus traditional technologies is costlier. However, given the low quality of evidence and the inconsistencies across studies, the precise difference in costs remains unclear. Attempts to estimate whether this increased cost is worth the expense are hampered by the uncertainty surrounding improvements in outcomes, such as cancer control and side effects of treatment. If the new technologies can consistently achieve better outcomes, then they may be cost effective.

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Section: Evidence Synthesismentioning

confidence: 99%

Section: Evidence Synthesismentioning

confidence: 99%

Section: Evidence Synthesismentioning

confidence: 99%

Section: Evidence Synthesismentioning

confidence: 99%

See 2 more Smart Citations

Cost of New Technologies in Prostate Cancer Treatment: Systematic Review of Costs and Cost Effectiveness of Robotic-assisted Laparoscopic Prostatectomy, Intensity-modulated Radiotherapy, and Proton Beam Therapy

et al. 2017

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“…Eleven papers specifically stated other methods of collecting the information on the pathway, which are as follows - [19,22,41,82,116,169] stated that the information was provided to them in some way, [79] through previous work (also consulted with experts and stakeholders), [128] online user input, and [21,24,60] used national guidelines.…”

Section: Obtaining the Pathwaymentioning

confidence: 99%

Clinical pathway modelling: a literature review

2019

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Hospital information systems are increasingly used as part of decision support tools for planning at strategic, tactical and operational decision levels. Clinical pathways are an effective and efficient approach in standardising the progression of treatment, to support patient care and facilitate clinical decision making. This literature review proposes a taxonomy of problems related to clinical pathways and explores the intersection between Information Systems (IS), Operational Research (OR) and industrial engineering. A structured search identified 175 papers included in the taxonomy and analysed in this review. The findings suggest that future work should consider industrial engineering integrated with OR techniques, with an aim to improving the handling of multiple scopes within one model, while encouraging interaction between the disjoint care levels and with a more direct focus on patient outcomes. Achieving this would continue to bridge the gap between OR, IS and industrial engineering, for clinical pathways to aid decision support.

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Issues in the Adoption of Robotic Surgery

Curet

2019

JAMA

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In the comparison of the foot immersion vs control interventions during exposure to hot, humid conditions, the whole-body sweat rate was significantly lower (114 g/h vs 179 g/h, respectively; difference, −66 g/h [95% CI, −109 to −23 g/h]; P = .003) and the thermal discomfort level was lower (45 mm vs 66 mm; difference, −21 mm [95% CI, −39 to −3 mm]; P = .02); however, heart rate was not (75/min vs 80/min; difference, −5/min [95% CI, −11/min to 1/min]; P = .14). The findings for whole-body sweat rate and heart rate were similar under very hot, dry conditions, but thermal discomfort was not significant (Table ).In the comparison of the self-dousing vs control interventions during exposure to hot, humid conditions, heart rate was significantly lower (75/min vs 80/min, respectively; difference, −5/min [95% CI, −10/min to 0/min]; P = .04) as well as the whole-body sweat rate (93 g/h vs 179 g/h; difference, −87 g/h [95% CI, −144 to −29 g/h]; P = .004) and thermal discomfort level (38 mm vs 66 mm; difference, −27 mm [95% CI, −49 to −6 mm]; P = .01). Results were similar under very hot, dry conditions.In the comparison of the self-dousing vs foot immersion intervention during exposure to very hot, dry conditions, the whole-body sweat rate and thermal discomfort level were lower with self-dousing; however, no differences between interventions were observed under hot, humid conditions. No differences in core temperature or effects of intervention order for any outcome were found.The reductions in heart rate with the foot immersion and self-dousing interventions attained clinical significance in hot, humid conditions as did the reductions in whole-body sweat rate with self-dousing in very hot, dry conditions. Discussion | In this preliminary study, foot immersion lowered sweating during exposure to both environmental conditions and lowered thermal discomfort only in hot, humid conditions. The self-dousing intervention lowered heart rate, sweating, and thermal discomfort under both environmental conditions and was more effective than the foot immersion intervention at reducing sweating and thermal discomfort in very hot, dry conditions. Core temperature was unaltered. However, morbidity and mortality from dehydration and cardiovascular failure during heat waves typically surpass those from hyperthermia alone. 5 Limitations include testing of only a small number of healthy volunteers. Responses must be evaluated among older adults and among those who have health conditions, are taking medications, or both, which could potentially disrupt thermoregulation. 6

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A Multidimensional Analysis of Prostate Surgery Costs in the United States: Robotic-Assisted versus Retropubic Radical Prostatectomy

Abstract: Monte-Carlo probabilistic sensitivity analysis demonstrated a 38% to 99% probability that RALP provides cost savings (depending on the perspective). Higher surgical consumable costs are offset by a decreased hospital stay, lower complication rate, and faster return to work.

Cited by 28 publications

References 104 publications

Cost of New Technologies in Prostate Cancer Treatment: Systematic Review of Costs and Cost Effectiveness of Robotic-assisted Laparoscopic Prostatectomy, Intensity-modulated Radiotherapy, and Proton Beam Therapy

Cost of New Technologies in Prostate Cancer Treatment: Systematic Review of Costs and Cost Effectiveness of Robotic-assisted Laparoscopic Prostatectomy, Intensity-modulated Radiotherapy, and Proton Beam Therapy

Clinical pathway modelling: a literature review

Issues in the Adoption of Robotic Surgery

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