Cost-Benefit Performance of Robotic Surgery Compared with Video-Assisted Thoracoscopic Surgery under the Japanese National Health Insurance System

Cost-Benefit Performance Simulation of Robot-Assisted Thoracic Surgery As Required for Financial Viability under the 2016 Revised Reimbursement Paradigm of the Japanese National Health Insurance System

“…The following reference data indicate the details of the reduction in cost for the dVSi operation on the assumption of 100 cases in one institution/year with the projected JNHIS reimbursement system; equipment fee ($4687 in 2012 reduced to $4464 in 2014), medical materials costs ($2860 in 2012 reduced to $1608 in 2014), and maintenance cost ($1800 in 2012 reduced to $518 in 2014, and raised to $778 again from January 2016 by Intuitive Surgical) ( Table 1A). 6) In institutions in which the total of all operation using dVSi is more than 100 a year, the cost required per RATS procedure was reduced from $6590 since October in 2014, and raised to $6850 again from January 2016 ( Table 1B). JNHIS reimbursement is based on the number of insurance points awarded for a given procedure or equipment used.…”

“…6) The governmental pricing of robotics will greatly influence the inclusion of this field in future medical treatment in Japan. The JNHIS has provided insurance coverage of all Japan since 1961.…”

“…6) The cost of RATS in Japan is of course greatly affected by the cost of the operator-controlled module, the ancillary equipment, and maintenance costs, but not by the surgeon's fee. Surgeons are paid a fixed salary determined by each university hospital, which affects the medical costs determined by the Ministry of Health and Welfare in Japan, regardless of the number or types of surgical procedures they perform.…”

“…[13][14][15][16][17] All costs were borne by the hospital in all cases, as was the situation in our previous report. 6) We employed the dVS (Intuitive Surgical, Inc., Sunnyvale, CA, USA) for RATS. Intuitive Surgical Inc. reduced the equipment fee from October 2014 and also reduced the maintenance costs from July 2012.…”

“…Subsequently, robot-assisted partial nephrectomy (RAPN) for small renal cell carcinomas (cT1N0M0) has also become eligible for reimbursement by the JNHIS since April 2016. According to several investigations of cost-effectiveness in countries outside Japan, robot-assisted thoracic surgery (RATS) has a financial deficit from the point of view of health economics in comparison with VATS, [1][2][3][4][5][6] despite differences in the medical health insurance systems. Other clinical fields are still waiting for reimbursement for the da Vinci Surgical System (dVS) operations, for example, gastrectomy, uterectomy, and thymectomy.…”