Cost-analysis comparison of robot-assisted laparoscopic radical cystectomy (RC) vs open RC

Authors


Richard Lee, James Buchanan Brady Foundation, Department of Urology, Weill Medical College of Cornell University, 525 E. 68th St., F9 West, New York, NY 10065, USA. e-mail: ril9010@med.cornell.edu

Abstract

What's known on the subject? and What does the study add?

The cost performance of RC has been studied in single institution series, each with its own particular clinical pathway and perioperative parameters. Given the relatively new technique, groups have reported different outcomes based on their unique experience. Most groups have demonstrated an increased materials cost associated with RC but a lower LOS.

The study systematically examines and summarizes the cost performance data of RC vs. OC. It reviews all relevant studies and presents them in a succinct overview of the current peer-reviewed literature.

OBJECTIVE

  • • To systematically review and compare the economic burden of open radical cystectomy (ORC) vs robot-assisted laparoscopic radical cystectomy (RALRC) with pelvic lymph node dissection and urinary diversion.

PATIENTS AND METHODS

  • • A Medline search was conducted to identify English language articles regarding RC with urinary diversion. The resulting articles were then further restricted by the terms ‘laparoscopic’, ‘robotic’, or ‘robotic-assisted’.In all, three articles were identified.
  • • Data from each of these articles were then collected on cost performance in addition to relevant clinical variables, such as length of stay (LOS), operative duration, and complication rates.
  • • When possible, data were subdivided by ileal conduit (IC), continent cutaneous diversion (CCD), and orthotopic neobladder (ON) subgroups.
  • • Direct costs resulting from ORC or RALRC with accompanying hospitalization were identified. The indirect costs of complications were considered.

RESULTS

  • • Despite an increased materials cost, RALRC was less expensive than ORC when the cost of complications was considered.
  • • RALRC was less expensive than ORC for IC and CCD, but the cost advantage deteriorated for ON.
  • • The largest cost drivers cited in the published data were LOS, operative durations, and daily hospitalizations costs.
  • • RALRC demonstrated shorter LOS compared with ORC, although this effect was insufficient to offset the increased cost of robotic surgery.
  • • Complications materially affected cost performance.

CONCLUSIONS

  • • Despite an increased materials cost, RALRC can be more cost efficient than ORC as a treatment for bladder cancer when the impact of complications are considered.
  • • This effect is most pronounced for patients undergoing IC.

Ancillary