Robotic and open radical prostatectomy in the public health sector: cost comparison

Abstract

RALP has shown a significant advantage with respect to length of stay and readmission rate. Based on the case-mix funding model RALP is poorly funded compared to its open equivalent. Queensland Health needs to plan on how robotic surgery is implemented and assess whether this technology is truly affordable in the public sector.

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

“…Of the 47 studies, 34 (72 %) were conducted in USA , two each in Switzerland (4 %) [51,52], Canada (4 %) [15,53], Ireland (4 %) [14,16] and Australia (4 %) [13,54], and one each in Denmark (2 %) [12], Italy (2 %) [55], Spain (2 %) [56], Sweden (2 %) [57] and the UK (2 %) [11].…”

“…Those studies reporting on costs only were predominantly from the USA (n = 7), and of the remaining four studies, one each was from Italy [55], Denmark [12], Canada [53] and Australia [54]. Three studies included the benefits and harms gained in their analysis [11,13,14].…”

What does it cost Medicare to diagnose and treat men with localized prostate cancer in the first year?

“…Hall et al . (2013) compared the costs of robotic and open radical prostatectomy in the public hospital system . As of 2012, the authors stated that 17 da Vinci robotic surgical systems were available in Australia, installed predominantly in private hospitals.…”

A Multidimensional Analysis of Prostate Surgery Costs in the United States: Robotic-Assisted versus Retropubic Radical Prostatectomy

“…The da Vinci Surgical System costs were calculated using a purchase price of $1.49 million, an annual maintenance fee of $149,000 for years 2 to 7 (first year included with purchase), and a 7-year depreciation period. Because of the current debate on whether these costs should be included in the general operating expenses of the hospital [48] or whether robotic programs need to "pay for themselves on a per-case basis" [49], two calculations were performed: one using robotic case volume (robotic amortization calculation-230 cases per year) and the other using overall hospital case volume (hospital overhead calculation-10,560 cases per year) [50] (see Appendix Multiple iterations within parts of the model were required. For example, costs for any subsequent treatment would be in addition to costs for initial surgery, and readmission costs for each complication were all included in the model, all adjusted by the frequency of these events.…”

“…Many economic studies leave robotic costs out of their analyses because of a lack of necessary information (e.g., databases do not report case volume) or because of the argument that per-case robotic costs are not directly dependent on clinical outcomes. However, there continues to be discussion on whether and how robotic system costs should be factored into economic analyses [48,49]. Therefore, we provided two methods for calculating robotic system costs, as well as providing sensitivity analyses.…”