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

Abstract

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.

Radical Cystectomy in England from 2013 to 2019 on 12,644 patients: An analysis of national trends and comparison of surgical approaches using Hospital Episode Statistics data

“…Increasing uptake of RARC may have cost implications, which we have not explored thoroughly in this study. Published systematic review analyses have concluded RARC may be cost‐effective compared to ORC 35 . Cost factors involved are predominantly based on equipment and operating room costs, length of stay, transfusion‐related requirements, complications, and readmission‐related expenditure 35 .…”

Stapled versus robot-sewn ileo-ileal anastomosis during robot-assisted radical cystectomy: a review of outcomes in urinary bladder cancer patients

“…The operative time, instruments used, length of hospital stay, and the numbers of annual cases were key drivers of costs. The results from the segmented costs indicated that RARC operating costs were higher and accounted for the largest proportion of total RARC costs [6]. The cost of endostapling devices makes RARC more expensive.…”

“…Robot-assisted radical cystectomy (RARC) is more expensive than open radical cystectomy [6]. One of the additional costs is due to the use of staples in ileo-ileal anastomoses.…”

The contemporary status of robotic intracorporeal neobladder

“…For this study, participating surgeons must have completed at least 30 procedures of each, which will be close to the plateau of their learning curves. The study will report on oncological, perioperative, functional, and cost outcomes for RARC with ICUD and hopefully make a major contribution to the literature, potentially resolving some outstanding areas of doubt in the argument for RARC and ICUD vs. the open approach [27] .…”