Exploratory activity-based direct cost analysis of robotic platforms in urologic surgery

Area of Science:

• Urology
• Surgical Technology
• Health Economics

Background:

• Robotic-assisted surgery (RAS) adoption is growing, but high system costs are a barrier.
• Newer robotic platforms aim to enhance competition and reduce procedural expenses.
• Evaluating the cost-effectiveness of different robotic systems is crucial for widespread adoption.

Purpose of the Study:

• To compare the direct in-hospital costs of three robotic platforms (Da Vinci, Hugo™ RAS, Versius®) in urologic surgery.
• To analyze cost variations between robotic systems for radical prostatectomy and partial nephrectomy procedures.
• To provide insights into the economic implications of adopting new robotic surgical technologies.

Main Methods:

• Retrospective single-center cost analysis of robotic-assisted urologic procedures performed in 2023.
• Inclusion of 284 robotic-assisted radical prostatectomies (RALP) and 77 robotic-assisted partial nephrectomies.
• Activity-based costing approach from the hospital perspective, encompassing equipment, maintenance, consumables, OR time, personnel, and hospitalization costs.

Main Results:

• For partial nephrectomy, no significant cost difference was found between Da Vinci and Hugo™ RAS, despite longer OR times for Hugo™.
• For RALP, mean total direct costs were comparable across Da Vinci, Hugo™ RAS, and Versius® platforms (p=0.13).
• Operative and OR times were significantly longer for Versius® in RALP, but this finding is exploratory due to small sample size.

Conclusions:

• Direct in-hospital costs for robotic-assisted urologic procedures appear broadly comparable across Da Vinci, Hugo™ RAS, and Versius® platforms in this single-center study.
• While overall costs may be similar, differences in operative and OR times warrant further investigation.
• Findings should be interpreted cautiously due to retrospective design, unbalanced cohorts, and limited sample size for Versius®.