Does the cost of robotic cholecystectomy translate to a financial burden?

Rosemurgy, Alexander S.; Ryan, Carrie E.; Klein, Richard L.; Sukharamwala, Prashant; Wood, Thomas W.; Ross, Sharona

doi:10.1007/s00464-014-3933-8

Cited by 24 publications

(19 citation statements)

References 22 publications

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“…However, in a study to evaluate and compare cost of care and reimbursement with robotic versus LC, Rosemurgy et al. [11] demonstrated that revenue, earnings before depreciation, interest, and taxes, and net income were similar after either approach, indicating costs with either approach were similar. In another study of cost report and analysis regarding RC, Bedeir et al.…”

Section: Discussionmentioning

confidence: 99%

Robotic versus conventional laparoscopic cholecystectomy: A comparative study of medical resource utilization and clinical outcomes

Wang

Lee

2017

The Kaohsiung J of Med Scie

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Conventional laparoscopic cholecystectomy (CLC) is currently the standard of surgical procedure for gallstone disease. Robotic cholecystectomy (RC) has revolutionized the field of minimally invasive surgery; it is safe and ergonomic, but expensive. The aim of this study is to compare the medical resource utilization and clinical outcomes between the two procedures. This study was conducted retrospectively by assessing data of the clinical outcomes and medical resource of 78 patients receiving RC and 367 patients receiving CLC. We reviewed the data of operation times, length of hospital stay, hospital charges, outpatient department visits, outpatient department service charges, and postoperative complications, which were retrieved from the health information system (HIS) database in this hospital. Patients in both groups had similar demographic and clinical features. The RC group had longer length of hospital stay (p=0.056), significantly longer operation time (p=0.035), and much more hospital charges (p=0.001). The RC group, however, experienced less postoperative complication rates (average 3.8% vs. 20.4%, p=0.001). Conversion rate was 1.9% in the CLC group versus 0% in the RC group (p=0.611). Most complications were mild, and following the Clavien-Dindo classification, there were two cases (2.5%) Grade I for the RC group; 50 cases (13.6%) Grade I and 14 cases (3.81%) Grade II for the CLC group (p<0.001 and 0.001, respectively). Procedure-related complications of Grade IIIa status were encountered in nine patients (2.45%) in the CLC group and none in the RC group (p=0.002).The RC group consumed more medical resources in the index hospitalization; however, they experienced significantly less postoperative complications.

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Section: Discussionmentioning

confidence: 99%

Robotic versus conventional laparoscopic cholecystectomy: A comparative study of medical resource utilization and clinical outcomes

Wang

Lee

2017

The Kaohsiung J of Med Scie

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“…In this setting, the value proposition is hard to ascertain [11]. Robotic systems/accessory packages tailored to the financial pressures associated with these wellworked out commodity outpatient procedures could be offered making the use of a robotic system more viable from a financial point of view assuming the quality robotquality std issues are favorable [12].…”

Section: Resultsmentioning

confidence: 99%

Financial modeling of current surgical robotic system in outpatient laparoscopic cholecystectomy: how should we think about the expense?

Schwaitzberg

2015

Surg Endosc

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The use of the extraordinary technology in the face of low-morbidity low-cost established minimally invasive procedures needs to withstand scrutiny of outcome assessment, revenue and expense considerations and appropriateness review in order to create financially viable approaches to high-volume minimally invasive procedures. Revenue estimates associated with outpatient reimbursement make it difficult to support these expenses, recognizing inpatient procedures represent a different net financial picture.

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“…Rosemurgy et al analyzed costs associated with robotic and laparoscopic cholecystectomy at a single institution from the viewpoint of a hospital stakeholder (44). Amortization costs were excluded because purchasing the robot was allocated across the entire surgery department.…”

Section: Rcmentioning

confidence: 99%

“…The top down analysis found a minimum additional cost of $2,600 per procedure (43) while the instrument price examination found equal instrument costs (19). Two studies found no significant difference (19,44) or minor savings of $391 dollars (45).…”

Section: Analysis Of Rcmentioning

confidence: 99%

Value-based assessment of robotic pancreas and liver surgery

Patti

Ore

Barrows

et al. 2017

Hepatobiliary Surg. Nutr.

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Current healthcare economic evaluations are based only on the perspective of a single stakeholder to the healthcare delivery process. A true value-based decision incorporates all of the outcomes that could be impacted by a single episode of surgical care. We define the value proposition for robotic surgery using a stakeholder model incorporating the interests of all groups participating in the provision of healthcare services: patients, surgeons, hospitals and payers. One of the developing and expanding fields that could benefit the most from a complete value-based analysis is robotic hepatopancreaticobiliary (HPB) surgery. While initial robot purchasing costs are high, the benefits over laparoscopic surgery are considerable. Performing a literature search we found a total of 18 economic evaluations for robotic HPB surgery. We found a lack of evaluations that were carried out from a perspective that incorporates all of the impacts of a single episode of surgical care and that included a comprehensive hospital cost assessment. For distal pancreatectomies, the two most thorough examinations came to conflicting results regarding total cost savings compared to laparoscopic approaches. The most thorough pancreaticoduodenectomy evaluation found non-significant savings for total hospital costs. Robotic hepatectomies showed no cost savings over laparoscopic and only modest savings over open techniques. Lastly, robotic cholecystectomies were found to be more expensive than the gold-standard laparoscopic approach. Existing cost accounting data associated with robotic HPB surgery is incomplete and unlikely to reflect the state of this field in the future. Current data combines the learning curves for new surgical procedures being undertaken by HPB surgeons with costs derived from a market dominated by a single supplier of robotic instruments. As a result, the value proposition for stakeholders in this process cannot be defined. In order to solve this problem, future studies must incorporate (I) quality of life, survival, and return to independent function alongside data such as (II) intent-to-treat analysis of minimally-invasive surgery accounting for conversions to open, (III) surgeon and institution experience and operative time as surrogates for the learning curve; and (IV) amortization and maintenance costs as well as direct costs of disposables and instruments.

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Does the cost of robotic cholecystectomy translate to a financial burden?

Cited by 24 publications

References 22 publications

Robotic versus conventional laparoscopic cholecystectomy: A comparative study of medical resource utilization and clinical outcomes

Robotic versus conventional laparoscopic cholecystectomy: A comparative study of medical resource utilization and clinical outcomes

Financial modeling of current surgical robotic system in outpatient laparoscopic cholecystectomy: how should we think about the expense?

Value-based assessment of robotic pancreas and liver surgery

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