Comparing costs of robotic, laparoscopic, and open partial nephrectomy

Area of Science:

• Urology
• Minimally Invasive Surgery
• Health Economics

Background:

• Laparoscopic (LPN) and robot-assisted partial nephrectomy (RPN) are minimally invasive alternatives to open partial nephrectomy (OPN) for renal tumors.
• Significant cost differences exist between these surgical approaches, necessitating economic evaluation.

Purpose of the Study:

• To compare the hospital costs associated with robot-assisted partial nephrectomy (RPN), laparoscopic partial nephrectomy (LPN), and open partial nephrectomy (OPN).

Main Methods:

• A retrospective cost analysis was conducted on 25 patients for each surgical approach (RPN, LPN, OPN).
• Variable costs (OR time, supplies, anesthesia, inpatient care) and fixed costs (equipment) were captured.
• Sensitivity analysis was performed to assess the impact of variable and fixed costs on overall expenditure.

Main Results:

• Overall variable costs were similar across RPN, LPN, and OPN ($6375 vs $6075 vs $5774).
• Operating room supplies were significantly higher for RPN and LPN ($2179, $1987) compared to OPN ($181).
• Inpatient stay costs were higher for OPN ($2418) than LPN ($1305) and RPN ($1274).
• RPN and LPN are less costly than OPN if hospital stay is ≤2 days and OR time is <195 and 224 minutes, respectively.
• Including fixed costs, OPN was less expensive than RPN and LPN unless operative times were reduced and robot utilization increased.

Conclusions:

• Minimizing operating room time and hospital stay can make RPN and LPN cost-equivalent to OPN based on variable costs.
• When fixed costs are included, OPN is more economical, but cost equivalence between RPN, LPN, and OPN is achievable with improved surgical efficiency.