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Cost-Effectiveness of Conventional vs Robotic-Assisted Laparoscopy in Gynecologic Oncologic Indications
Patricia Marino1, Gilles Houvenaeghel, Fabrice Narducci
1*Paoli Calmettes Institute, Marseille, France; †Inserm UMR 912 SESSTIM, Marseille, France; ‡Oscar Lambret Center, Lille, France; §Claudius Regaud Institute, Toulouse, France; ∥Gustave Roussy Institute, Villejuif, France; ¶Hôpital Européen Georges Pompidou, Paris, France; #Hôpital Edouard Herriot, Lyon, France; **Henri Becquerel Center, Rouen, France; ††Bergonié Institute, Bordeaux, France; ‡‡Val D'aurelle Center, Montpellier, France; §§Rene Gauducheau Center, Nantes, France; ∥∥Hôpital Nord, Marseille, France; and ¶¶La Casamance, private hospital, Aubagne, France.
Objective:
Robotic surgical techniques are known to be expensive, but they can decrease the cost of hospitalization and improve patients' outcomes. The aim of this study was to compare the costs and clinical outcomes of conventional laparoscopy vs robotic-assisted laparoscopy in the gynecologic oncologic indications.
Methods:
Between 2007 and 2010, 312 patients referred for gynecologic oncologic indications (endometrial and cervical cancer), including 226 who underwent conventional laparoscopy and 80 who underwent robot-assisted laparoscopy, were included in this prospective multicenter study. The direct costs, operating theater costs, and hospital costs were calculated for both surgical strategies using the microcosting method.
Results:
Based on an average number of 165 surgical cases performed per year with the robot, the total extra cost of using the robot was €1456 per intervention. The robot-specific costs amounted to €2213 per intervention, and the cost of the robot-specific surgical supplies was €957 per intervention. The cost of the surgical supplies specifically required by conventional laparoscopy amounted to €1432, which is significantly higher than that of the robotic supplies (P < 0.001). Hospital costs were lower in the case of the robotic strategy (€2380 vs €2841, P < 0.001) because these patients spent less time in intensive care (0.38 vs 0.85 days). Operating theater costs were higher in the case of the robotic strategy (€1490 vs €1311, P = 0.0004) because the procedure takes longer to perform (4.98 hours vs 4.38 hours).
Conclusions:
The main driver of additional costs is the fixed cost of the robot, which is not compensated by the lower hospital room costs. The robot would be more cost-effective if robotic interventions were performed on a larger number of patients per year or if the purchase price of the robot was reduced. A shorter learning curve would also no doubt decrease the operating theater costs, resulting in financial benefits to society.
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