Cost comparison of laparoscopic versus radical retropubic prostatectomy

To determine the cost of laparoscopic radical prostatectomy (LRP) versus open radical retropubic prostatectomy (RRP) in an actual clinical setting, we analyzed the cost data from a single institution comparing LRP and RRP. LRP is increasing in prevalence, yet questions remain regarding its higher cost versus open RRP.

A chart and cost review was performed for consecutive patients undergoing LRP (n = 30) and RRP (n = 67) between May 2003 and August 2004. The clinical characteristics, operative techniques, and radiographic and pathologic information were recorded. Detailed cost information for room and board, laboratory, pharmacy, radiology, operating room, surgical supplies, anesthesia, recovery room, electrocardiography, and respiratory services were obtained.

The total cost of the procedure was significantly more for LRP than for RRP (6,760 dollars versus 5,253 dollars, P < 0.001). Most of this difference was due to surgical supply (1,202 dollars LRP versus 145 dollars RRP, P < 0.001) and operating room costs (1,601 dollars LRP versus 1,141 dollars RRP, P < 0.001). The room and board and pharmacy costs were significantly lower for LRP than for RRP because of the shorter mean length of stay (1.73 days versus 2.37 days, P < 0.001). The laboratory/pathology and radiology costs were not significantly different. No significant difference was found in the Gleason score, preoperative prostate-specific antigen level, subject age, positive surgical margins, lymph node involvement, or seminal vesicle involvement between the two groups.

At a single institution, the actual LRP costs were significantly greater than the costs for RRP, and this was predominantly due to the higher surgical supply and operating room costs.