Health care cost consequences of using robot technology for hysterectomy: a register-based study of consecutive patients during 2006–2013

Abstract

The objective of this study is to examine the costs attributable to robotic-assisted laparoscopic hysterectomy from a broad healthcare sector perspective in a register-based longitudinal study. The population in this study were 7670 consecutive women undergoing hysterectomy between January 2006 and August 2013 in public hospitals in Denmark. The interventions in the study were total and radical hysterectomy performed robotic-assisted laparoscopic hysterectomy (RALH), total laparoscopic hysterectomy (TLH), or open abdominal hysterectomy (OAH). Service use in the healthcare sector was evaluated 1 year before to 1 year after the surgery. Tariffs of the activity-based remuneration system and the diagnosis-related grouping case-mix system were used for valuation of primary and secondary care, respectively. Costs attributable to RALH were estimated using a difference-in-difference analytical approach and adjusted using multivariate linear regression. The main outcome measure was costs attributable to OAH, TLH, and RALH. For benign conditions RALH generated cost savings of € 2460 (95% CI 845; 4075) per patient compared to OAH and non-significant cost savings of € 1045 (95% CI -200; 2291) when compared with TLH. In cancer patients RALH generated cost savings of 3445 (95% CI 415; 6474) per patient when compared to OAH and increased costs of € 3345 (95% CI 2348; 4342) when compared to TLH. In cancer patients undergoing radical hysterectomy, RALH generated non-significant extra costs compared to OAH. Cost consequences were primarily due to differences in the use of inpatient service. There is a cost argument for using robot technology in patients with benign disease. In patients with malignant disease, the cost argument is dependent on comparator.

Long term resource consequences of a nationwide introduction of robotic surgery for women with early stage endometrial cancer

“…Smith et al reported that the overall hospital charge was 40% higher with RMIS compared to laparoscopy and open access surgery [31]. In contrast to our findings, Laursen et al found that RMIS generated cost savings of $3861 per women when compared with open access surgery and increased costs of €$3749 when compared with laparoscopy in Danish cancer patients [32]. Important differences between the study of…”

Robotic-Assisted Laparoscopic Abdominal Cerclage Placement During Pregnancy

“…We believe that in the optimal setting, RALAC can be a safe and cost-effective approach to abdominal cerclage [20,27]. The ideal time to perform an abdominal cerclage is before pregnancy; however, similar efficacy of laparoscopic and abdominal cerclage has been reported regardless of the timing of the procedure, and our experience echoes these findings.…”

“…Multiple studies have suggested a higher cost of robotic surgery compared with benign laparoscopic gynecologic surgery [23][24][25]. Others have shown equal costs or benefits to robotic gynecologic surgery when taking into additional factors, such as hospital stay, complications, established robotics in the hospital, and surgeon expertise, even when compared with other minimally invasive approaches [26,27]. When a robot is already available in a surgical setting, the cost of robotic surgery drops drastically and similar hospital cost can be attained for laparoscopy and robotics [28].…”

Robot Assisted Laparoscopic Surgery in Gynaecology: An Evolving Assistive Technology

“…61 There is, therefore, no overall consensus regarding the cost-effectiveness of robot-assisted surgery when compared to other approaches for gynaecological procedures. 12,62,63 Cost-effectiveness analyses are complex and are severely limited due to variations in the surgeries compared, the techniques and instruments used, and the experience of the surgeon. 12 Furthermore, global differences in health care economics and health care models used (public or private) mean that total costs, and therefore cost-effectiveness, will vary significantly between countries utilizing robot-assisted surgery.…”