Cost comparison of robotic, laparoscopic, and open partial nephrectomy

Area of Science:

• Urology
• Surgical Oncology
• Health Economics

Background:

• Partial nephrectomy is a standard treatment for kidney tumors.
• Comparing the direct costs of open partial nephrectomy (OPN), laparoscopic partial nephrectomy (LPN), and robot-assisted LPN (RALPN) is crucial for healthcare resource allocation.
• Understanding cost-effectiveness guides surgical decision-making and influences adoption of new technologies.

Purpose of the Study:

• To compare the direct costs associated with three surgical approaches for partial nephrectomy: OPN, LPN, and RALPN.
• To evaluate the cost-effectiveness of each surgical technique based on operating room time, equipment use, and length of stay.
• To identify the most economically favorable surgical option for partial nephrectomy.

Main Methods:

• A meta-analysis of nonoverlapping studies was conducted to gather data on operating room time, equipment use, and length of stay for OPN, LPN, and RALPN.
• Cost models were developed using institutional data, with robotic costs and maintenance amortized over seven years.
• One- and two-way sensitivity analyses were performed to assess the impact of variable changes on cost-effectiveness.

Main Results:

• The meta-analysis included data from 7 RALPN, 18 LPN, and 8 OPN studies, totaling 477, 2220, and 2745 procedures, respectively.
• Weighted mean operating room times were 188 minutes for RALPN, 200 minutes for LPN, and 193 minutes for OPN.
• Laparoscopic partial nephrectomy (LPN) emerged as the most cost-effective approach with a mean direct cost of $10,311, showing significant cost advantages over OPN ($11,427) and RALPN ($11,962).

Conclusions:

• Laparoscopic partial nephrectomy (LPN) is more cost-effective than open partial nephrectomy (OPN) due to a shorter length of stay, despite similar operating room times.
• LPN is the most cost-effective option overall, primarily driven by lower instrumentation costs, even when compared to robot-assisted LPN (RALPN) which has a longer length of stay.
• Robot-assisted LPN (RALPN) incurs high maintenance and instrumentation costs, which are only partially offset by a shorter length of stay; further evidence on oncological and functional equivalence to OPN is needed to define its future role.