Cost-analysis of robot-assisted radical cystectomy in Europe: A cross-country comparison

Mjaess, Georges; Diamand, Romain; Aoun, Fouad; Assenmacher, G.; Assenmacher, Christophe; Verhoest, G.; Holz, Serge; Naudin, Michel; Ploussard, Guillaume; Mari, Andrea; Tay, Andrea; Issa, Rami; Roumiguié, M.; Bajeot, A.; Umari, Paolo; Sridhar, Ashwin; Kelly, John D.; Hendricksen, Kees; Einerhand, Sarah; Mertens, Laura S.; Sánchez-Salas, Rafael; Gallardo, Anna Colomer; Quackels, Thierry; Peltier, Alexandre; Pradère, Benjamin; Moschini, Marco; Roumeguère, Thierry; Albisinni, Simone

doi:10.1016/j.ejso.2022.07.023

Cited by 9 publications

(5 citation statements)

References 21 publications

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“…The reported impact on operating time may be hard to accept and put in place in busy departments with long waiting lists. A recent trans‐European cost analysis for iRARC was published, demonstrating that operating time (along with hospital stay) is the major cost element of this procedure [19]. Increasing such a variable by 60–120 min would result in a significant increase of roughly 1000–3000 Euros per patient in European centres.…”

Section: Discussionmentioning

confidence: 99%

Teaching robotic cystectomy: prospective pilot clinical validation of the ERUS training curriculum

et al. 2023

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To provide the first clinical validation of the European Association of Urology Robotic Urology Section (ERUS) curriculum for training in robot-assisted radical cystectomy with intracorporeal urinary diversion (iRARC). Patients and MethodsThe ERUS proposed a structured curriculum, divided into 11 steps, to train novice surgeons and help overcome the steep learning curve associated with iRARC. In this study, one trainee completed the curriculum under the mentorship of an expert. Twenty-one patients were operated on by the trainee following the proposed iRARC curriculum [(t)iRARC group] and were compared with 42 patients treated with the standard of care by the mentor [(m)iRARC group]. To evaluate curriculum safety, peri-operative outcomes, surgical margins and complications were assessed. Propensity-score matching (1:2) was used to identify comparable (t)iRARC and (m)iRARC cases. Matched variables included age, body mass index, neoadjuvant therapy, American Society of Anesthesiologists score and cT stage. Mann-Whitney and chi-squared tests were used to compare peri-and postoperative outcomes between the two cohorts. To evaluate curriculum efficacy, steps attempted and completed by the trainee were assessed and studied as a function of growing surgical experience of the trainee. ResultsThe trainee progressed in proficiency-based training through steps of increasing difficulty. No differences in estimated blood loss, positive soft tissue margins, number of resected lymph nodes, overall and high-grade complications, or 90-day readmissions between the (t)iRARC and (m)iRARC groups were observed (all P > 0.05). However, operating time was significantly longer in the (t)iRARC group (P = 0.01). Of the 209 available steps, the trainee attempted 168 (80%) and successfully performed 125 (60%). Increasing experience was associated with more steps being successfully performed (P < 0.001). ConclusionsThe proposed ERUS curriculum assists na€ ıve surgeons during the learning curve for iRARC and should be encouraged in order to guarantee optimal outcomes during the learning phase of this procedure.

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Section: Discussionmentioning

confidence: 99%

Teaching robotic cystectomy: prospective pilot clinical validation of the ERUS training curriculum

et al. 2023

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“…But in addition to focusing on the cost of surgery, when studying the cost-effectiveness of surgery, quality measures such as quality of life and survival, and even costs related to the treatment of complications need to be considered. But there are also some European countries where RARC costs depend mainly on patient hospital stay and surgery time, rather than robotic instruments ( 41 ). Unfortunately, the studies we included did not report the cost-effectiveness-related indicators of the two types of surgery, and we were unable to draw conclusions by integrating them.…”

Section: Discussionmentioning

confidence: 99%

Robotic-assisted versus standard laparoscopic radical cystectomy in bladder cancer: A systematic review and meta-analysis

Long¹,

Wang²,

Ni³

et al. 2022

Front. Oncol.

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BackgroundThis study aimed to evaluate the efficacy and safety of robotic-assisted radical cystectomy (RARC) versus laparoscopic radical cystectomy (LRC) in the treatment of bladder cancer.MethodsTwo researchers independently searched PubMed, Embase, Cochrane, and CBM using the index words to identify the qualified studies which included randomized controlled trials (RCTs) and non-randomized controlled trials (prospective and retrospective studies), and the investigators scanned references of these articles to prevent missing articles. Differences in clinical outcomes between the two procedures were analyzed by calculating odds risk (OR) and mean difference (MD) with an associated 95% confidence interval (CI).ResultsSixteen comparative studies were included in the meta-analysis with 1467 patients in the RARC group and 897 patients in the LRC group. The results indicated that RARC could significantly decrease blood loss (P = 0.01; MD: -82.56, 95% CI: -145.04 to -20.08), and complications 90 days or more after surgery, regardless of whether patients were Grade ≤ II (P = 0.0008; OR: 0.63, 95% CI: 0.48 to 0.82) or Grade ≥ III (P = 0.006; OR: 0.59, 95% CI: 0.40 to 0.86), as well as overall complications (P: 0.01; OR = 0.52; 95% CI: 0.32 to 0.85). However, there was no statistical difference between the two groups at total operative time, intraoperative complications, transfusion rate, short-term recovery, hospital stay, complications within 30 days of surgery, and bladder cancer-related mortality.ConclusionsThe meta-analysis demonstrates that RARC is a safe and effective treatment for bladder cancer, like LRC, and patients with RARC benefit from less blood loss and fewer long-term complications related to surgery, and should be considered a viable alternative to LRC. There still need high-quality, larger sample, multi-centric, long-term follow-up RCTs to confirm our conclusion.

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“…Others have taken this exploration further. Mjaess et al ran a cost analysis of robot assisted radical cystectomy in Europe (6). They have found that costs varied significantly across European countries and were mainly attributed to the length of stay and operating time, rather than robotic instrumentation.…”

Section: To the Editormentioning

confidence: 99%

Robotic pyeloplasty: Technological global panacea or geo-surgical nightmare?

Nikolinakos,

Chatzikrachtis,

Donkov

et al. 2024

Arch Ital Urol Androl

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To the Editor, Pelvi-ureteric junction obstruction (PUJO) is a well-recognised clinical entity characterised by functionally significant impairment of drainage of urine at the level of the pelvi-ureteric junction due to extrinsic or intrinsic obstruction and is encountered both by adult and paediatric urologists alike. Management of PUJO has been surgical historically, and the gold standard has been an open Anderson-Hynes dismembered pyeloplasty. [...]

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Cost-analysis of robot-assisted radical cystectomy in Europe: A cross-country comparison

Cited by 9 publications

References 21 publications

Teaching robotic cystectomy: prospective pilot clinical validation of the ERUS training curriculum

Teaching robotic cystectomy: prospective pilot clinical validation of the ERUS training curriculum

Robotic-assisted versus standard laparoscopic radical cystectomy in bladder cancer: A systematic review and meta-analysis

Robotic pyeloplasty: Technological global panacea or geo-surgical nightmare?

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