Local Cost Structures and the Economics of Robot Assisted Radical Prostatectomy

Abstract

The inpatient costs of robotic assisted prostatectomy are volume dependent and cost equivalence with generalist radical retropubic prostatectomy is possible at higher volume RAP specialty centers. While RAP may be cost competitive with RRP at high cost hospitals or high volume RAP specialist centers, this procedure would exist at a cost premium to RRP in other practice settings.

Evidence-Based Comparison of Robotic and Open Radical Prostatectomy

“…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.…”

“…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].…”

“…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]. Bolenz et al found that the median direct cost was more for RALP than for ORP ($6,752 vs. $4,437, p < 0.001)[43].…”

Outcomes after robot-assisted laparoscopic radical prostatectomy

“…Scales et al [51] showed the cost equivalence of RALRP with ORP based on 10 cases per week and cost superiority based on 14 cases per week in the United States. However, in many other countries, the high installation and maintenance costs of this technology prevent its widespread implementation, even in high-volume centres.…”

A selected review and personal experience with robotic prostatectomy: implications for adoption of this new technology in the United Kingdom

“…Finally, the considerable costs make this a serious financial proposal by any hospital. 42 The cost includes the initial capital investment as well as the maintenance cost plus the use of any special laparoscopic instruments which have a programmed senescence ( Table 2 lays out potential set up and running costs in developing a robotic programme).…”