The New Economics of Radical Prostatectomy: Cost Comparison of Open, Laparoscopic and Robot Assisted Techniques

Lotan, Yair; Cadeddu, Jeffrey A.; Gettman, Matthew T.

doi:10.1097/01.ju.0000139714.09832.47

Cited by 243 publications

(172 citation statements)

References 20 publications

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“…Two studies have reported higher costs during hospital stay for RALP compared with RRP [1,2], whereas another study has suggested lower total costs for RALP, although higher direct costs [3]. A valid comparison of the costs for the two techniques cannot be done, because the calculations are based on different models [13].…”

Section: Discussionmentioning

confidence: 97%

“…The equipment is expensive and the operating time is, at least during the learning period, longer than in radical retropubic prostatectomy (RRP). It is hoped that these costs will be outweighed by savings due to shorter postoperative hospital care, reduced number of blood transfusions, less need for postoperative analgesics [1,2,4,5] and shorter sick leave.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Open retropubic prostatectomy versus robot-assisted laparoscopic prostatectomy: A comparison of length of sick leave

Hohwü

Akre

Pedersen

et al. 2009

Scandinavian Journal of Urology and Nephrology

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Objective. It remains uncertain whether the increased direct costs of robot-assisted laparoscopic radical prostatectomy (RALP) are outweighed by cost savings due to shorter postoperative hospital care and shorter sick leave. This study compared the length of sick leave after RALP with that after radical retropubic prostatectomy (RRP). Material and methods. In a cohort study, information on length of sick leave was retrieved for 274 working men undergoing radical prostatectomy (127 RALP and 147 RRP). Data on confounders such as physical workload, average salary, body mass index and disease characteristics were collected from the medical records. Cox regression models were used to compare the treatment groups. Results. The median number of days with sick leave was 11 in the RALP group and 49 in the RRP group. After adjustment for confounders, patients in the RALP group were twice as likely to return to work at any time during follow-up (hazard ratio 02.13, 95% confidence interval 1.62Á2.80). High physical workload, low salary and high tumour grade were more common in the RRP group and associated with longer sick leave. Conclusions. Patients in the RALP group had shorter postoperative hospital stay and less need for paid sick leave than patients in the RRP group. These data indicate that RALP shortens the convalescence. Part of this difference may, however, be attributable to different selection of patients and different a priori expectations among patients and their doctors. A prospective randomized study is advocated, although blinding is unfeasible.

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Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Open retropubic prostatectomy versus robot-assisted laparoscopic prostatectomy: A comparison of length of sick leave

Hohwü

Akre

Pedersen

et al. 2009

Scandinavian Journal of Urology and Nephrology

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“…Given the large number of men with prostate cancer, the effects of treatment have major public health implications, including patient counseling and financial costs. The existing studies comparing the costs of robotic and open radical prostatectomy, however, are limited in their scope, addressing only the costs of the procedure and initial hospital stay[40,41,42]. These studies do not consider subsequent costs from complications, treatment of side effects, or cancer recurrence, which may be substantial in this patient population.…”

Section: Comparison and Discussion Of Orp And Ralpmentioning

confidence: 99%

“…Cost studies by Lotan et al, Mouraviev et al, Scales et al, and Bolenz et al specifically compared RALP with ORP and reported higher operative costs with RALP, although comparisons were restricted to the costs of the procedure and the duration of initial hospitalization[40,41,42,43]. Scales et al reported that inpatient costs of RALP are volume dependent and that cost equivalence with ORP is possible at high-volume specialty centers; however, they do not report actual cost data[42].…”

Section: Comparison and Discussion Of Orp And Ralpmentioning

confidence: 99%

Evidence-Based Comparison of Robotic and Open Radical Prostatectomy

Lowrance

Tarin

Shariat

2010

The Scientific World JOURNAL

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The rapid adoption of robotic-assisted laparoscopic radical prostatectomy (RALP) has occurred despite a lack of high-quality evidence demonstrating its oncologic advantages, safety, or cost effectiveness compared with open radical retropubic prostatectomy (ORP). This review examines the current literature comparing ORP and RALP, focusing on perioperative, oncologic, functional, and economic outcomes.

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“…Cost-analyses from a urological perspective have focused exclusively on the robot-assisted laparoscopic prostatectomy model. [95][96][97][98][99][100] However, some extrapolations are still possible. When Computer Motion, Inc., initially merged with Intuitive Surgical, Inc., in 2003, the cost of the da Vinci system was slightly higher than US$1 000 000.…”

Section: The Futurementioning

confidence: 99%

Robotic renal surgery: The future or a passing curiosity?

Warren

Silva

Caumartin

et al. 2013

CUAJ

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The development, advancement and clinical integration of robotic technology in surgery continue at a staggering pace. In no other discipline has this rapid evolution occurred to a greater degree than in urology. Although radical prostatectomy has grown to become the prototypical application for the robot, the role of the robot in renal surgery remains controversial. Herein we review the literature on robotic renal surgery. A comprehensive PubMed literature search was performed to identify all published reports relating to robotic renal surgery. All clinically related articles involving human participants were critically appraised in this review. Fifty-one clinical articles were included, encompassing robot-assisted pyeloplasty, nephrectomy, nephroureterectomy, living-donor nephrectomy and partial nephrectomy. Feasibility has been shown for each of these procedures. Robot-assisted techniques have been described for almost all renal-related procedures. However, the intersect between feasibility and necessity as it pertains to robotic renal surgery has yet to be defined. Also, the high cost of surgical robotic technology mandates critical appraisal before adoption, especially in a publicly funded health care system, such as the one present in Canada. RésuméLe développement, le perfectionnement et l'intégration en milieu clinique de la technologie robotique en contexte opératoire se poursuit à un rythme stupéfiant. Aucune autre discipline n'a vu cette évolution rapide à un niveau aussi élevé que l'urologie. Alors que la prostatectomie radicale en est devenue l'application prototype, le rôle de la robotique en chirurgie rénale demeure controversé. Dans l'article qui suit, nous passons en revue la littérature portant sur l'emploi de la robotique en chirurgie rénale. Une recherche exhaustive dans la base de données PubMed a été effectuée afin de cerner les rapports sur le sujet. Tous les rapports cliniques portant sur des sujets humains ont été évalués. Cinquante et un articles cliniques ont été inclus dans notre analyse, incluant des cas, tous assistés par robot, de pyéloplas-tie, de néphrectomie, de néphro-urétérectomie, de néphrectomie chez des donneurs vivants et de néphrectomie partielle. Pour chacune de ces interventions, la faisabilité a été démontrée. Des techniques assistées par robot ont été décrites pour pratiquement tous

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The New Economics of Radical Prostatectomy: Cost Comparison of Open, Laparoscopic and Robot Assisted Techniques

Cited by 243 publications

References 20 publications

Open retropubic prostatectomy versus robot-assisted laparoscopic prostatectomy: A comparison of length of sick leave

Open retropubic prostatectomy versus robot-assisted laparoscopic prostatectomy: A comparison of length of sick leave

Evidence-Based Comparison of Robotic and Open Radical Prostatectomy

Robotic renal surgery: The future or a passing curiosity?

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