Cost analysis of open radical cystectomy versus robot‐assisted radical cystectomy

Bansal, Sukhchain; Dogra, Tara; Smith, Peter; Amran, M.; Auluck, Ishna; Bhambra, Maninder; Sura, M.; Rowe, Edward; Koupparis, Anthony

doi:10.1111/bju.14044

Cited by 34 publications

(32 citation statements)

References 38 publications

(50 reference statements)

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“…The perceived additional cost associated with robotic surgery is a common argument against adopting the technology. Although the robot itself, the consumables and maintenance are a considerable financial investment, there are numerous examples, where robotic surgery has proven to be cost effective in high volume centres [58, 59] or even cost saving [60, 61], be it within certain, realistic, anticipated complication levels. Although the financial comparison between LAG and OG has not been formally assessed (although expected as part of the LOGICA trial), the cost of RAG was compared to LAG in a multicentre prospective match cohort study and found to be around $5000 higher ($13432 vs $8090) [17].…”

Section: Long-term Outcomesmentioning

confidence: 99%

Robotic-assisted gastrectomy for gastric cancer: a European perspective

2019

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Gastrectomy is the mainstay treatment for gastric cancer. To reduce the associated patient burden, minimally invasive gastrectomy was introduced in almost 30 years ago. The increase in the availability of surgical robotic systems led to the first robotic-assisted gastrectomy to be performed in 2002 in Japan. Robotic gastrectomy however, particularly in Europe, has not yet gained significant traction. Most reports to date are from Asia, predominantly containing observational studies. These cohorts are commonly different in the tumour stage, location (particularly with regards to gastroesophageal junctional tumours) and patient BMI compared to those encountered in Europe. To date, no randomised clinical trials have been performed comparing robotic gastrectomy to either laparoscopic or open equivalent. Cohort studies show that robotic gastrectomy is equal oncological outcomes in terms of survival and lymph node yield. Operative times in the robotic group are consistently longer compared to laparoscopic or open gastrectomy, although evidence is emerging that resectional surgical time is equal. The only reproducibly significant difference in favour of robot-assisted gastrectomy is a reduction in intraoperative blood loss and some studies show a reduction in the risk of pancreatic fistula formation.

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Section: Long-term Outcomesmentioning

confidence: 99%

Robotic-assisted gastrectomy for gastric cancer: a European perspective

2019

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“…With many units now routinely performing intracorporeal urinary diversion (ICUD), further benefits can be derived by a reduction in incision size, postoperative pain, and bowel-related complications [10] . A recent study demonstrated that introduction of RARC and ICUD represented the principal factor leading to the benefits of a RC enhanced-recovery programme [11] , and furthermore cost-efficiency analyses have shown promising results even when factoring in purchase, consumable and maintenance expenses [12] , [13] .…”

Section: Introductionmentioning

confidence: 99%

Expanding the indications of robotic surgery in urology: A systematic review of the literature

Pal

Koupparis

2018

Arab Journal of Urology

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ObjectivesTo evaluate the recent developments in robotic urological surgery, as the introduction of robotic technology has overcome many of the difficulties of pure laparoscopic surgery enabling surgeons to perform complex minimally invasive procedures with a shorter learning curve. Robot-assisted surgery (RAS) is now offered as the standard for various surgical procedures across multiple specialities.MethodsA systematic search of MEDLINE, PubMed and EMBASE databases was performed to identify studies evaluating robot-assisted simple prostatectomy, salvage radical prostatectomy, surgery for urolithiasis, distal ureteric reconstruction, retroperitoneal lymph node dissection, augmentation ileocystoplasty, and artificial urinary sphincter insertion. Article titles, abstracts, and full text manuscripts were screened to identify relevant studies, which then underwent data extraction and analysis.ResultsIn all, 72 studies evaluating the above techniques were identified. Almost all studies were retrospective single-arm case series. RAS appears to be associated with reduced morbidity, less blood loss, reduced length of stay, and comparable clinical outcomes in comparison to the corresponding open procedures, whilst having a shorter operative duration and learning curve compared to the equivalent laparoscopic techniques.ConclusionEmerging data demonstrate that the breadth and complexity of urological procedures performed using the da Vinci® platform (Intuitive Surgical Inc., Sunnyvale, CA, USA) is continually expanding. There is a gaining consensus that RAS is producing promising surgical results in a wide range of procedures. A major limitation of the current literature is the sparsity of comparative trials evaluating these procedures.

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“…We initially identified 315 studies from PubMed, Web of Science, and Cochrane Library databases. Of the 315 studies, 11 were included in this study [11, 13, 19–27]. The characteristics of the included studies are listed in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…Two studies compared ORC to LRC [19, 20], and nine compared ORC to RARC [11, 13, 21–27]. Of the studies that compared ORC to RARC, four were single-institutional retrospective studies [11, 13, 21, 22], one was a single-institutional RCT [23], and the remaining four were administrative large database studies [24–27]. The QOL was measured in one study [23] and no significant difference in QOL scores between ORC and RARC was found.…”

Section: Resultsmentioning

confidence: 99%

“…Smith et al conducted a cost analysis between ORC and RARC [11], and the results show a total cost advantage of $1630/case for RARC. In contrast, the cost-analysis by Bansal et al showed a total cost advantage of approximately $1945/case for ORC [13]. Michels et al [14] conducted a cost simulation of ORC and RARC and found that RARC costs €3365 more than ORC at 30 days.…”

Section: Introductionmentioning

confidence: 99%

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Cost comparison between open radical cystectomy, laparoscopic radical cystectomy, and robot-assisted radical cystectomy for patients with bladder cancer: a systematic review of segmental costs

et al. 2019

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BackgroundRobot-assisted radical cystectomy is becoming a common treatment for bladder carcinoma. However, in comparison with open radical cystectomy, its cost-effectiveness has not been confirmed. Although few published reviews have compared total costs between the two surgical procedures, no study has compared segmental costs and explained their impact on total costs.MethodsA systematic review was conducted based on studies on the segmental costs of open, laparoscopic, and robot-assisted radical cystectomy using PubMed, Web of Science, and Cochrane Library databases to provide insight into cost-effective management methods for radical cystectomy. The segmental costs included operating, robot-related, complication, and length of stay costs. A sensitivity analysis was conducted to determine the impact of the annual number of cases on the per-case robot-related costs.ResultsWe identified two studies that compared open and laparoscopic surgeries and nine that compared open and robotic surgeries. Open radical cystectomy costs were higher than those of robotic surgeries in two retrospective single-institution studies, while robot-assisted radical cystectomy costs were higher in 1 retrospective single-institution study, 1 randomized controlled trial, and 4 large database studies. Operating costs were higher for robotic surgery, and accounted for 63.1–70.5% of the total robotic surgery cost. Sensitivity analysis revealed that robot-related costs were not a large proportion of total surgery costs in institutions with a large number of cases but accounted for a large proportion of total costs in centers with a small number of cases.ConclusionsThe results show that robot-assisted radical cystectomy is more expensive than open radical cystectomy. The most effective methods to decrease costs associated with robotic surgery include a decrease in operating time and an increase in the number of cases. Further research is required on the cost-effectiveness of surgeries, including quality measures such as quality of life and quality-adjusted life years.

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Cost analysis of open radical cystectomy versus robot‐assisted radical cystectomy

Abstract: High ongoing equipment costs remain a large barrier to the cost of RARC falling. However, minimal improvements in patient quality of life would be required to offset this difference.

Cited by 34 publications

References 38 publications

Robotic-assisted gastrectomy for gastric cancer: a European perspective

Robotic-assisted gastrectomy for gastric cancer: a European perspective

Expanding the indications of robotic surgery in urology: A systematic review of the literature

Cost comparison between open radical cystectomy, laparoscopic radical cystectomy, and robot-assisted radical cystectomy for patients with bladder cancer: a systematic review of segmental costs

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