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

Abstract

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.

Outpatient Robotic surgery: Considerations for the Anesthesiologist

“…Further data about which patients have consistently good or poor outcomes after outpatient robotic surgery and what types of procedures are most appropriate might be useful. There is conflicting data on whether the use of robot-assisted techniques in outpatient surgery increases or decreases costs [ 13 , 16 , 50 ]; facility fees for outpatient procedures are lower than for inpatient ones, but the costs for the robot and associated disposables may outweigh this benefit.…”

Value-based assessment of robotic pancreas and liver surgery

“…Fuller reached a similar conclusion regarding the high costs of robotic surgery and attributed the major driver to computer-enforced obsolescence of ISI Endowrist instruments (47). The ISI business model is reflected in the company's earnings; 46% ($1,033 millions) of Intuitive's $2.27 billion annual revenue is derived from instrumentation versus $835 million for robot purchasing and $397 million for maintenance (46). As a result, economic projections about future robotic surgery cannot be based on studies of prior costs.…”

“…Four analyzed direct hospital costs (42-45) while one measured top-down costs (46) and one measured instrument costs (19). Two of the four hospital cost analyses demonstrated increased hospital costs of at least $1,900 (42,43).…”

“…Finally, Schwaitzberg conducted a top-down analysis of robot versus laparoscopic cholecystectomy using data from Intuitive Surgical's 2014 Investor Presentation and 2013 Investor Report (46). The accounting evaluated capital revenues ($835 million), service revenues ($397 million), and instrument revenues ($1,033 million) divided by the total number of robotic cholecystectomies performed divided by the number of installed robotic systems.…”