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Cost comparison of robotic, laparoscopic, and open radical prostatectomy for prostate cancer.
Eur Urol. 2010 Mar; 57(3):453-8.EU

Abstract

BACKGROUND

Demand and utilization of minimally invasive approaches to radical prostatectomy have increased in recent years, but comparative studies on cost are lacking.

OBJECTIVE

To compare costs associated with robotic-assisted laparoscopic radical prostatectomy (RALP), laparoscopic radical prostatectomy (LRP), and open retropubic radical prostatectomy (RRP).

DESIGN, SETTING, AND PARTICIPANTS

The study included 643 consecutive patients who underwent radical prostatectomy (262 RALP, 220 LRP, and 161 RRP) between September 2003 and April 2008.

MEASUREMENTS

Direct and component costs were compared. Costs were adjusted for changes over the time of the study.

RESULTS AND LIMITATIONS

Disease characteristics (body mass index, preoperative prostate-specific antigen, prostate size, and Gleason sum score 8-10) were similar in the three groups. Nerve sparing was performed in 85% of RALP procedures, 96% of LRP procedures, and 90% of RRP procedures (p<0.001). Lymphadenectomy was more commonly performed in RRP (100%) compared to LRP (22%) and RALP (11%) (p<0.001). Mean length of hospital stay was higher for RRP than for LRP and RALP. The median direct cost was higher for RALP compared to LRP or RRP (RALP: $6752 [interquartile range (IQR): $6283-7369]; LRP: $5687 [IQR: $4941-5905]; RRP: $4437 [IQR: $3989-5141]; p<0.001). The main difference was in surgical supply cost (RALP: $2015; LRP: $725; RRP: $185) and operating room (OR) cost (RALP: $2798; LRP: $2453; RRP: $1611; p<0.001). When considering purchase and maintenance costs for the robot, the financial burden would increase by $2698 per patient, given an average of 126 cases per year.

CONCLUSIONS

RALP is associated with higher cost, predominantly due to increased surgical supply and OR costs. These costs may have a significant impact on overall cost of prostate cancer care.

Authors+Show Affiliations

Department of Urology, University of Texas Southwestern Medical Center at Dallas, TX 75390-9110, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

19931979

Citation

Bolenz, Christian, et al. "Cost Comparison of Robotic, Laparoscopic, and Open Radical Prostatectomy for Prostate Cancer." European Urology, vol. 57, no. 3, 2010, pp. 453-8.
Bolenz C, Gupta A, Hotze T, et al. Cost comparison of robotic, laparoscopic, and open radical prostatectomy for prostate cancer. Eur Urol. 2010;57(3):453-8.
Bolenz, C., Gupta, A., Hotze, T., Ho, R., Cadeddu, J. A., Roehrborn, C. G., & Lotan, Y. (2010). Cost comparison of robotic, laparoscopic, and open radical prostatectomy for prostate cancer. European Urology, 57(3), 453-8. https://doi.org/10.1016/j.eururo.2009.11.008
Bolenz C, et al. Cost Comparison of Robotic, Laparoscopic, and Open Radical Prostatectomy for Prostate Cancer. Eur Urol. 2010;57(3):453-8. PubMed PMID: 19931979.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cost comparison of robotic, laparoscopic, and open radical prostatectomy for prostate cancer. AU - Bolenz,Christian, AU - Gupta,Amit, AU - Hotze,Timothy, AU - Ho,Richard, AU - Cadeddu,Jeffrey A, AU - Roehrborn,Claus G, AU - Lotan,Yair, Y1 - 2009/11/11/ PY - 2009/09/08/received PY - 2009/11/02/accepted PY - 2009/11/26/entrez PY - 2009/11/26/pubmed PY - 2010/3/4/medline SP - 453 EP - 8 JF - European urology JO - Eur Urol VL - 57 IS - 3 N2 - BACKGROUND: Demand and utilization of minimally invasive approaches to radical prostatectomy have increased in recent years, but comparative studies on cost are lacking. OBJECTIVE: To compare costs associated with robotic-assisted laparoscopic radical prostatectomy (RALP), laparoscopic radical prostatectomy (LRP), and open retropubic radical prostatectomy (RRP). DESIGN, SETTING, AND PARTICIPANTS: The study included 643 consecutive patients who underwent radical prostatectomy (262 RALP, 220 LRP, and 161 RRP) between September 2003 and April 2008. MEASUREMENTS: Direct and component costs were compared. Costs were adjusted for changes over the time of the study. RESULTS AND LIMITATIONS: Disease characteristics (body mass index, preoperative prostate-specific antigen, prostate size, and Gleason sum score 8-10) were similar in the three groups. Nerve sparing was performed in 85% of RALP procedures, 96% of LRP procedures, and 90% of RRP procedures (p<0.001). Lymphadenectomy was more commonly performed in RRP (100%) compared to LRP (22%) and RALP (11%) (p<0.001). Mean length of hospital stay was higher for RRP than for LRP and RALP. The median direct cost was higher for RALP compared to LRP or RRP (RALP: $6752 [interquartile range (IQR): $6283-7369]; LRP: $5687 [IQR: $4941-5905]; RRP: $4437 [IQR: $3989-5141]; p<0.001). The main difference was in surgical supply cost (RALP: $2015; LRP: $725; RRP: $185) and operating room (OR) cost (RALP: $2798; LRP: $2453; RRP: $1611; p<0.001). When considering purchase and maintenance costs for the robot, the financial burden would increase by $2698 per patient, given an average of 126 cases per year. CONCLUSIONS: RALP is associated with higher cost, predominantly due to increased surgical supply and OR costs. These costs may have a significant impact on overall cost of prostate cancer care. SN - 1873-7560 UR - https://www.unboundmedicine.com/medline/citation/19931979/Cost_comparison_of_robotic_laparoscopic_and_open_radical_prostatectomy_for_prostate_cancer_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0302-2838(09)01150-6 DB - PRIME DP - Unbound Medicine ER -