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Cost-minimization analysis of robotic-assisted, laparoscopic, and abdominal sacrocolpopexy
John P Judd1, Nazema Y Siddiqui, Jason C Barnett
1Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina 27710, USA. john.judd@duke.edu
Study Objective:
To perform a cost-minimization analysis comparing robotic-assisted, laparoscopic, and abdominal sacrocolpopexy.
Design:
Cost-minimization analysis using a micro-costing approach (Canadian Task Force classification III).
Measurements And Main Results:
A decision model was developed to compare the costs (2008 US dollars) of robotic, laparoscopic, and abdominal sacrocolpopexy. Our model included operative time, risk of conversion, risk of transfusion, and length of stay (LOS) for each method. Respective baseline estimates for robotic, laparoscopic, and abdominal sacrocolpopexy procedures included operative time (328, 269, and 170 minutes), conversion (1.4%, 1.8%, and 0%), transfusion (1.4%, 1.8%, 3.8%), and LOS (1.0, 1.8, and 2.7 days). Two models were used, the Robot Existing model, that is, current hospital ownership of a robotic system, and the Robot Purchase model, that is, initial hospital purchase of a robotic system, with purchase and maintenance costs amortized and distributed across robotic procedures. Sensitivity analyses were performed to assess the effect of varying each parameter through its range. For the Robot Existing robot model, robotic sacrocolpopexy was the most expensive, $8508 per procedure compared with laparoscopic sacrocolpopexy at $7353 and abdominal sacrocolpopexy at $5792. Robotic and laparoscopic sacrocolpopexy became cost-equivalent only when robotic operative time was reduced to 149 minutes, robotic disposables costs were reduced to $2132, or laparoscopic disposable costs were increased to $3413. Laparoscopic and abdominal sacrocolpopexy became cost-equivalent only when laparoscopic disposable costs were reduced to $668, mean LOS for abdominal sacrocolpopexy was increased to 5.6 days, or surgeon reimbursement for abdominal sacrocolpopexy exceeded $2213. The addition of robotic purchase and maintenance costs resulted in an incremental increase of $581, $865, and $1724 per procedure when these costs were distributed over 60, 40, and 20 procedures per month, respectively.
Conclusion:
Robotic sacrocolpopexy was more expensive compared with the laparoscopic or abdominal routes under the baseline assumptions.
