Cost-analysis of Implementing Robot-assisted Versus Open Pancreatoduodenectomy

Area of Science:

• Surgical Oncology
• Minimally Invasive Surgery
• Health Economics

Background:

• Robot-assisted pancreatoduodenectomy (RPD) is increasingly adopted in high-volume centers as an alternative to open pancreatoduodenectomy (OPD).
• Concerns persist regarding the higher costs associated with RPD compared to OPD, which have not been extensively studied.

Purpose of the Study:

• To conduct a cost-analysis of robot-assisted pancreatoduodenectomy (RPD) implementation versus open pancreatoduodenectomy (OPD).
• To evaluate the impact of surgical experience on the cost-effectiveness and outcomes of RPD.

Main Methods:

• A post-hoc cost-analysis comparing consecutive RPD and OPD cases from January 2015 to May 2024 in a single high-volume center.
• Patient selection for OPD mirrored RPD eligibility criteria to minimize bias, focusing on total hospital costs and length of stay.
• Sensitivity analyses were performed, excluding the initial phase of RPD experience.

Main Results:

• RPD was associated with a shorter hospital stay (10 vs. 12 days) but higher initial mean total costs (€4,804 more).
• In the latter half of RPD experience, outcomes significantly improved, including reduced hospital stay, pancreatic fistula, and delayed gastric emptying rates.
• Consequently, RPD costs decreased substantially, becoming comparable to OPD costs (€21,778 vs. €21,013).

Conclusions:

• Initial implementation of RPD leads to higher costs than OPD.
• Growing surgical experience with RPD significantly enhances outcomes and cost-efficiency.
• RPD costs decrease by approximately one-third with experience, achieving cost parity with OPD, warranting further large-scale randomized trials.