Assessment of Out-of-Pocket Costs for Robotic Cancer Surgery in US Adults

Abstract

IMPORTANCE Expensive technologies-including robotic surgery-experience rapid adoption without evidence of superior outcomes. Although previous studies have examined perioperative outcomes and costs, differences in out-of-pocket costs for patients undergoing robotic surgery are not well understood. OBJECTIVE To assess out-of-pocket costs and total payments for 5 types of common oncologic procedures that can be performed using an open or robotic approach. DESIGN, SETTING, AND PARTICIPANTS A retrospective, cross-sectional, propensity scoreweighted analysis was performed using deidentified insurance claims for 1.9 million enrollees from the MarketScan database from January 1, 2012, to December 31, 2017. The final study sample comprised 15 893 US adults aged 18 to 64 years who were enrolled in an employer-sponsored health plan. Patients underwent either an open or robotic radical prostatectomy, hysterectomy, partial colectomy, radical nephrectomy, or partial nephrectomy for a solid-organ malignant neoplasm.

Senhance Robotic Platform System for Gynecological Surgery

“…8 Robotic surgical platforms have been used successfully for years for complicated procedures, many in complex oncological situations, which can benefit from minimally invasive surgery advantages. 9 Gynecological patients with benign (i.e., fibroids) or malignant disease or comorbidities (i.e., obesity) no longer have to be subjected to open laparotomy, but instead benefit from both surgical and post-surgical advantages offered by robotic minimally invasive surgery. 6,7,10 Once laparoscopic assisted hysterectomy techniques began being used, patient recovery and satisfaction were remarkably improved compared to prior patients receiving either the AH or VH procedures.…”

“…There have been barriers to robotic surgical platforms in the past; namely the expense of the platform for hospitals and patient billing, training of users, and justification of use via clinical evidence of benefit. 4,7,9 The robotic systems have been in larger institutions for 20 years and in gynecological use for 15. 4 Short and long term clinical benefit data for surgeons and patients have been established.…”

“…4 Short and long term clinical benefit data for surgeons and patients have been established. 9 Although robotic peri-operative costs are perceived to be higher than standard, a study of robotic oncological procedures demonstrated patient out-ofpocket cost and the payer's total payments were lower compared to other approaches. 9 As more hospitals incorporate the robotic systems, more surgeons are trained and can use the systems, which increases the number of users able to use the system as well as helps lower the overall system expense for the institution.…”

“…9 Although robotic peri-operative costs are perceived to be higher than standard, a study of robotic oncological procedures demonstrated patient out-ofpocket cost and the payer's total payments were lower compared to other approaches. 9 As more hospitals incorporate the robotic systems, more surgeons are trained and can use the systems, which increases the number of users able to use the system as well as helps lower the overall system expense for the institution. Not only can the cost efficiency increase as the surgical volume increases, robotic hysterectomy can be feasible in benign disease or may be more cost effective with reductions in operating room time and direct costs in patients with comorbidities or abnormally large uteri.…”

Robotic Transanal Total Mesorectal Excision (RTaTME): State of the Art

“…A recent retrospective, propensity score-weighed analysis using insurance claims from the MarketScan database showed that the robotic approach was associated with lower out-of-pocket costs for five types of common oncological procedures compared to open surgery [ 66 ].…”