Is robotic lobectomy cheaper? A micro-cost analysis

Abstract

Higher capital costs and operating room costs associated with Lobectomy via Robot Assisted Thoracic Surgery (RATS) have previously been suggested as the principal contributors to the elevated overall cost. This study uses a micro-costing approach to a previous analysis of clinical outcomes of RATS, Video-Assisted Thoracic Surgery (VATS) and Open Lobectomy to evaluate the most significant cost drivers for the higher cost of robot-assisted lobectomy. A micro-costing model was developed to reflect the pathway of patients from day of surgery through the first 30 days following lobectomy. Costs were provided for RATS, VATS and Open approaches. Sensitivity analysis was performed specifically in the area of staff costs. A threshold sensitivity analysis of the overall cost components was also performed. Total cost per case for the RATS approach was €13,321 for the VATS approach €11,567, and for the Open approach €12,582. The overall cost differences were driven primarily by the elevated consumable costs associated with RATS Lobectomy. Capital costs account for a relatively small proportion of the per-case cost difference. This study presents a detailed analysis of the cost drivers for lobectomy, modelled for the three primary surgical approaches. We believe this is a useful tool for surgeons, hospital management, and service commissioning agencies to accurately and comprehensively determine where cost savings can be applied in their programme to improve the cost-effectiveness of RATS lobectomy.

Comparing Thoracoscopic and Robotic Lobectomy Using a Nationally Representative Database

“…One hypothesis for the excess charges associated with robotic lobectomy includes increased intraoperative resource utilization of consumables and other equipment such as instruments. 20 This lends itself to further discussion surrounding the benefits and cost of robotic lobectomy.…”

Approaches and outcomes of Robotic-Assisted Thoracic Surgery (RATS) for lung cancer: a narrative review

“…A recent systematic review highlighted that the major component of robotic costs is the disposable equipment, accounting for a difference of 1100€ per case when compared to VATS. The staff costs, due to the longer operative times, are also high [ 10 ]. An additional limit has been the absence of tactile feedback.…”

Robotic lung resection: a narrative review of the current role on primary lung cancer treatment

“…However, in micro-cost analyzes such as that performed by Shanahan et al the cost difference is only €515 between VATS and RATS. The major contributor to cost increase is Intuitive ® consumable materials (instruments, robotic staplers, etc...) which correspond to 63% of the increased value ( 59 ). In cost-effectiveness analysis made by Heiden et al the difference between RATS and VATS when analyzed from a societal perspective was $247.77, resulting in an Incremental cost-effectiveness ratio of $113,388.80 per quality-adjusted life-years ( 60 ).…”