Cost-Effectiveness Analysis of Robotically Assisted Laparoscopy for Newly Diagnosed Uterine Cancers

Abstract

Objective We assessed the direct costs of 3 surgical approaches in uterine cancer and the cost impact of incorporating robot-assisted surgery. Methods A cost system that allocates the actual cost of resources used to treat each patient, as opposed to borrowing cost data from a billing system, was used to determine direct costs for patients who underwent surgery for uterine cancer from 2009–2010. These costs included all aspects of surgical care up to 6 months after discharge. Total amortized direct costs (AC) included the capital cost of 3 dual console DaVinci Si platforms with 5 years of service contracts. Non-amortized costs (NAC) were also calculated (excluded capital costs). Modeling was performed to estimate the mean cost of surgical care for patients presenting with endometrial cancer from 2007–2010 Results Of 436 cases (132 laparoscopic, 262 robotic, 42 laparotomy), total mean AC/case was $20,489 (laparoscopy), $23,646 (robot), and $24,642 (laparotomy) (P<0.05 [robot vs laparoscopy]; P=0.6 [robot vs laparotomy]). Total NAC/case was $20,289, $20,467, and $24,433, respectively (P=0.9 [robot vs laparoscopy]; P=0.03 [robot vs laparotomy]). The planned surgical approach in 2007 was laparoscopy-68%, robot-8%, and laparotomy-24% compared to 26%, 64%, and 9%, respectively, in 2010 (P<0.001). The modeled mean AC/case was $21,738 in 2007 and $22,678 in 2010 (+$940). NAC was $21,298 in 2007 and $20,573 in 2010 (−$725). Conclusion Laparoscopy is least expensive when including capital acquisition costs. Laparoscopy and robotic surgery are comparable if upfront costs are excluded. There is cost neutralization with the robot when it helps decrease laparotomy rates.

A Systematic Review of Economic Evaluations of the Use of Robotic Assisted Laparoscopy in Surgery Compared with Open or Laparoscopic Surgery

“…In eight (17 %) studies an attempt was made to justify the key parameters that the models were based upon [11, 14-17, 19, 44, 51]. Justification of key parameters was satisfactory in six of these [11,[14][15][16][17]44].…”

“…Thus, a model requires having a long enough time-horizon to capture all events. In three (6 %) studies the details of the model used were not clear [34,35,44]. In eight (17 %) studies an attempt was made to justify the key parameters that the models were based upon [11, 14-17, 19, 44, 51].…”

“…1 Flow diagram of the selection of studies for the systematic review evaluation used economic models [11, 14-17, 19, 20, 34, 35, 44, 51]. Seven (15 %) of these considered populations suffering from malignancies [11,15,17,19,20,34,44], and 2 (4 %) others considered benign diseases (morbid obesity and ureteropelvic junction obstruction) [35,51]. In a further two (4 %) there was a mixed group of diagnosis (benign and malign) [14,16].…”

Robotic Surgery in the Management of Endometrial Cancer

“…A cost effective analysis of robotically assisted management of new endometrial cancer was performed by Leitao et al [71] The costs were inclusive of all surgical aspects of care provided up to 6 months following discharge. In that study, the total mean amortized cost per case was $20,487 for laparoscopy, 20,467 for robotically assisted, and $24, 642 for laparotomy.…”

The effect of obesity on clinical and economic outcomes in robotic endometrial cancer surgery

“…4 Other authors have also reported clinical benefits for robotic-assisted laparoscopic surgery for primary endometrial cancer. [7][8][9][10] Some authors have reported equal or improved costs for robotic-assisted laparoscopy, 5,11 whereas other studies have shown increased costs when compared to straight stick laparoscopy not taking into account the proportion of cases performed open. [12][13][14][15] These data assessed the specific costs of the surgical episode alone and did not look at societal costs such as time off work nor quality of life.…”