Assessing the cost effectiveness of robotics in urological surgery – a systematic review
Open Access
- 22 March 2012
- journal article
- review article
- Published by Wiley in BJU International
- Vol. 110 (10), 1544-1556
- https://doi.org/10.1111/j.1464-410x.2012.11015.x
Abstract
OBJECTIVES Although robotic technology is becoming increasingly popular for urological procedures, barriers to its widespread dissemination include cost and the lack of long term outcomes. This systematic review analyzed studies comparing the use of robotic with laparoscopic and open urological surgery. These three procedures were assessed for cost efficiency in the form of direct as well as indirect costs that could arise from length of surgery, hospital stay, complications, learning curve and postoperative outcomes. METHODS A systematic review was performed searching Medline, Embase and Web of Science databases. Two reviewers identified abstracts using online databases and independently reviewed full length papers suitable for inclusion in the study. RESULTS Laparoscopic and robot assisted radical prostatectomy are superior with respect to reduced hospital stay (range 1-1.76 days and 1-5.5 days, respectively) and blood loss (range 482-780 mL and 227-234 mL, respectively) when compared with the open approach (range 2-8 days and 1015 mL). Robot assisted radical prostatectomy remains more expensive (total cost ranging from US $2000-$39 215) than both laparoscopic (range US $740-$29 771) and open radical prostatectomy (range US $1870-$31 518). This difference is due to the cost of robot purchase, maintenance and instruments. The reduced length of stay in hospital (range 1-1.5 days) and length of surgery (range 102-360 min) are unable to compensate for the excess costs. Robotic surgery may require a smaller learning curve (20-40 cases) although the evidence is inconclusive. CONCLUSIONS Robotic surgery provides similar postoperative outcomes to laparoscopic surgery but a reduced learning curve. Although costs are currently high, increased competition from manufacturers and wider dissemination of the technology could drive down costs. Further trials are needed to evaluate long term outcomes in order to evaluate fully the value of all three procedures in urological surgery.Keywords
This publication has 37 references indexed in Scilit:
- The effect of the approach to radical prostatectomy on the profitability of hospitals and surgeonsBJU International, 2010
- Comparative Effectiveness of Prostate Cancer Surgical Treatments: A Population Based Analysis of Postoperative OutcomesJournal of Urology, 2010
- Prospective Randomized Controlled Trial of Robotic versus Open Radical Cystectomy for Bladder Cancer: Perioperative and Pathologic ResultsEuropean Urology, 2009
- OPEN VERSUS ROBOTIC CYSTECTOMY: RE-EXAMINING THE COST COMPARISONJournal of Urology, 2009
- Prostatectomía radical laparoscópica versus robóticaArchivos Espanoles de Urologia, 2007
- Robotic prostatectomy: facts or fiction?The Lancet, 2007
- A Prospective Comparison of Robotic and Laparoscopic PyeloplastyAnnals of Surgery, 2006
- LOCAL COST STRUCTURES AND THE ECONOMICS OF ROBOT ASSISTED RADICAL PROSTATECTOMYJournal of Urology, 2005
- MAKING ENDS MEET: A COST COMPARISON OF LAPAROSCOPIC AND OPEN RADICAL RETROPUBIC PROSTATECTOMYJournal of Urology, 2004
- Assessing the quality of reports of randomized clinical trials: Is blinding necessary?Controlled Clinical Trials, 1996