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

Robotic-assisted surgery has become increasingly widespread across surgical specialties over the last two decades. However, the high costs associated with robotic systems remain a major limitation to their diffusion. Recently introduced robotic platforms aim to increase market competition and potentially reduce procedural costs. This study evaluated the direct in-hospital costs associated with three robotic platforms in urologic surgery. A retrospective single-center cost analysis was conducted on robotic-assisted procedures performed in 2023. A total of 284 robotic-assisted radical prostatectomies (RALP) were included (200 Da Vinci, 77 Hugo™ RAS, and 7 Versius^®), while 77 robotic-assisted partial nephrectomies were analyzed (57 Da Vinci and 20 Hugo™ RAS). Partial nephrectomy analysis therefore involved only two platforms. Cost estimation was performed using an activity-based costing approach from the hospital/provider perspective, including direct costs related to robotic equipment, maintenance, consumables, operating room occupancy, personnel, and hospitalization. For partial nephrectomy, no statistically significant difference in total direct cost was observed between Da Vinci (€7856.89 ± 1335.76) and Hugo™ (€8226.36 ± 1481.85) platforms (p = 0.16), although operating room time and related costs were significantly higher with Hugo™ (p = 0.03 and p = 0.04, respectively). For RALP, mean total costs were €8077.99 (Da Vinci), €7867.92 (Hugo™), and €8430.76 (Versius^®), without statistically significant differences (p = 0.13). Operative and operating room times were significantly longer with Versius^® (p < 0.05). Due to the limited number of Versius^® procedures, findings involving this platform should be considered exploratory. In this single-center experience, direct in-hospital costs associated with robotic-assisted urologic procedures appeared broadly comparable across platforms. However, findings should be interpreted cautiously given the retrospective design, unbalanced cohorts, absence of detailed case-mix adjustment, and the limited Versius^® sample size.