One-year healthcare costs after robotic-assisted and laparoscopic partial and radical nephrectomy: a cohort study

Abstract

Objective Despite the wide-spread adoption of robotic-assisted surgery (RAS), the cost–benefit implications for partial (PN) and radical nephrectomy (RN) versus laparoscopic surgery (Lap) is not well established. We sought to examine the trend of adoption and 1-year healthcare expenditure of PN and RN, and compare 1-year expenditures of RAS versus Lap for PN and RN. Patients and methods This cohort study used the MerativeTM MarketScan® Databases between 2013 and 2020. A total of 5,353 patients with kidney cancer undergoing PN (2,980, 55.7%) or RN (2,373, 44.3%). We compared open-conversion, length of stay (LOS), index expenditure, 1-year healthcare expenditure and utilization, and missed work-days between RAS and Lap for PN and RN. Results Adoption of PN increased overtime (47.0% to 55.8%), mainly driven by robotic PN increase. Among PN, RAS had lower open-conversion, shorter LOS and lower index expenditure than Lap. Among RN, RAS had shorter LOS, and similar open-conversion and index expenditures. During 1-year post-discharge, RAS had lower hospital outpatient visits (IRR = 0.92, 95% CI = 0.85, 0.99, p = 0.029) and office-based visits (IRR = 0.91, 95% CI = 0.86, 0.96, p = 0.002) for PN, translating to a 1-day less (95% CI = 0.25, 1.75, p = 0.008) missed from work for RAS. Following RN, RAS had lower 1-year readmission than Lap (O.R = 0.72, 95% CI = 0.55, 0.94, p = 0.018). RAS and Lap had comparable 1-year post-discharge expenditures for both PN (mean difference, MD = -$475, 95% CI = -$4362, $3412, p = 0.810) and RN (MD = -$4,204, 95% CI = -$13,837, $5430, p = 0.404). Conclusion At index surgery, RAS was associated with shorter LOS for both PN and RN, and lower open-conversion and expenditures for PN. RAS and Lap had comparable 1-year total expenditures, despite lower healthcare visits for RAS.

Time trends in surgical provision and cancer-specific outcomes in patients with stage T2-3 kidney cancer: a SEER-based study

“…This trend underscores the multifaceted influences affecting surgical choices. Several studies based on different databases revealed that the advent of robotic and laparoscopic surgeries has significantly enhanced the application of PN ( 49 – 54 ). These minimally invasive approaches have been pivotal in refining the procedure's efficacy and patient outcomes.…”

Health Service Use and Costs During Pregnancy Among Privately Insured Individuals With Congenital Heart Disease

“…Data about individual patients are integrated from all care settings (eg, inpatient, outpatient, and outpatient pharmacy), maintaining health care use and cost record connections at the patient level. MarketScan reports the payments that came on the paid claims submitted by various insurance carriers and provides data about total payments (total costs to all payers) and payments made by patients (OOP costs) for their coinsurance, copayment, and/or deductible . We identified enrollees aged 18 to 45 years with at least 1 full year of continuous enrollment from January 1, 2010, to December 31, 2016.…”

“…MarketScan reports the payments that came on the paid claims submitted by various insurance carriers and provides data about total payments (total costs to all payers) and payments made by patients (OOP costs) for their coinsurance, copayment, and/or deductible. 9 , 10 , 11 We identified enrollees aged 18 to 45 years with at least 1 full year of continuous enrollment from January 1, 2010, to December 31, 2016.…”

Role of Robotic-Assisted Surgery in Public Health: Its Advantages and Challenges

“…Long-term healthcare utilization costs tend to be reduced due to more excellent proficiency with robotic surgery and a decline in Emergency room and office visits [ 21 ]. The main advantages of minimally invasive surgery for the patient are less pain medication use, quicker healing, better cosmesis, and fewer wound problems.…”