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Costing methodologies in robotic ventral hernia repair: a scoping review
Kristian Als Nielsen1,2,3, Karsten Kaiser4,5,6, Per Helligsø7
1Department of General Surgery, University Hospital of Southern Denmark, Aabenraa, Denmark. kristian.als.nielsen3@rsyd.dk.
Summary
The financial impact of robotic ventral hernia repair is unclear due to inconsistent cost reporting methods. Standardized guidelines are needed for accurate economic evaluations of robotic surgery.
Area of Science:
- Surgical Oncology
- Health Economics
- Minimally Invasive Surgery
Background:
- The cost-effectiveness of robotic minimally invasive surgery (RMIS) compared to traditional methods like laparoscopy and open surgery is debated.
- Ventral hernia repair is a common procedure where the financial implications of using robotic assistance are particularly unclear.
Purpose of the Study:
- To systematically review the literature on the costs associated with robotic-assisted ventral hernia repair (rVHR).
- To analyze the methodologies employed in reporting rVHR costs and their impact on study conclusions.
- To identify gaps in the economic evidence for rVHR.
Main Methods:
- A systematic search was conducted following Joanna Briggs Institute and PRISMA-ScR guidelines across major databases (Ovid EMBASE, Ovid MEDLINE, Cochrane CENTRAL).
- Studies reporting rVHR costs were included, with data extracted on study characteristics, costing methodology, perspectives, and reported costs.
- Two independent researchers screened records and extracted data.
Main Results:
- Of 4,856 screened records, 43 studies were included, predominantly from the United States (74%).
- Most studies (95%) were basic cost-comparison analyses, with limited full economic evaluations.
- Costing methodologies were varied: 42% used hospital charges, 23% used top-down/bottom-up approaches. Hospital perspective (77%) dominated over payer perspective (12%).
- Comparison results were mixed: 49% found non-robotic surgery less costly, 22% favored robotic, and 29% found no significant difference.
- Inconsistent reporting of cost components, such as robotic system acquisition, was common.
Conclusions:
- A significant gap exists in robust financial evidence for robotic-assisted ventral hernia repair.
- The reliance on varied costing methods and incomplete cost component reporting hinders accurate economic assessment.
- Standardized costing guidelines specific to robotic minimally invasive surgery are essential for improving transparency and validity in future economic evaluations.
