A Multidimensional Analysis of Prostate Surgery Costs in the United States: Robotic-Assisted versus Retropubic Radical Prostatectomy

Akash Bijlani; April E Hebert; Mike Davitian; Holly May; Mark Speers; Robert Leung; Nihal E Mohamed; Henry S Sacks; Ashutosh Tewari

doi:10.1016/j.jval.2015.12.019

A Multidimensional Analysis of Prostate Surgery Costs in the United States: Robotic-Assisted versus Retropubic Radical Prostatectomy

Value Health. 2016 Jun;19(4):391-403. doi: 10.1016/j.jval.2015.12.019. Epub 2016 Mar 4.

Authors

Akash Bijlani¹, April E Hebert¹, Mike Davitian², Holly May³, Mark Speers³, Robert Leung⁴, Nihal E Mohamed⁴, Henry S Sacks⁵, Ashutosh Tewari⁶

Affiliations

¹ Intuitive Surgical, Sunnyvale, CA, USA.
² Intuitive Surgical, Sunnyvale, CA, USA; Health Advances, LLC, San Francisco, CA, USA.
³ Health Advances, LLC, Weston, MA, USA; Health Advances, LLC, San Francisco, CA, USA.
⁴ Department of Urology, Mount Sinai Hospital, New York, NY, USA.
⁵ Thomas C. Chalmers Clinical Trials Unit, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
⁶ Department of Urology, Mount Sinai Hospital, New York, NY, USA. Electronic address: ash.tewari@mountsinai.org.

PMID: 27325331
DOI: 10.1016/j.jval.2015.12.019

Abstract

Background: The economic value of robotic-assisted laparoscopic prostatectomy (RALP) in the United States is still not well understood because of limited view analyses.

Objectives: The objective of this study was to examine the costs and benefits of RALP versus retropubic radical prostatectomy from an expanded view, including hospital, payer, and societal perspectives.

Methods: We performed a model-based cost comparison using clinical outcomes obtained from a systematic review of the published literature. Equipment costs were obtained from the manufacturer of the robotic system; other economic model parameters were obtained from government agencies, online resources, commercially available databases, an advisory expert panel, and the literature. Clinical point estimates and care pathways based on National Comprehensive Cancer Network guidelines were used to model costs out to 3 years. Hospital costs and costs incurred for the patients' postdischarge complications, adjuvant and salvage radiation treatment, incontinence and potency treatment, and lost wages during recovery were considered. Robotic system costs were modeled in two ways: as hospital overhead (hospital overhead calculation: RALP-H) and as a function of robotic case volume (robotic amortization calculation: RALP-R). All costs were adjusted to year 2014 US dollars.

Results: Because of more favorable clinical outcomes over 3 years, RALP provided hospital ($1094 savings with RALP-H, $341 deficit with RALP-R), payer ($1451), and societal ($1202) economic benefits relative to retropubic radical prostatectomy.

Conclusions: Monte-Carlo probabilistic sensitivity analysis demonstrated a 38% to 99% probability that RALP provides cost savings (depending on the perspective). Higher surgical consumable costs are offset by a decreased hospital stay, lower complication rate, and faster return to work.

Keywords: RALP; RRP; cost-comparison analysis; economic.

Publication types

Comparative Study

MeSH terms

Costs and Cost Analysis
Health Care Costs
Hospital Costs / statistics & numerical data*
Humans
Laparoscopy / economics
Male
Meta-Analysis as Topic
Models, Economic
Postoperative Complications / economics
Prostatectomy / economics*
Prostatectomy / methods*
Prostatic Neoplasms / economics*
Prostatic Neoplasms / surgery*
Robotic Surgical Procedures / economics*
Robotic Surgical Procedures / methods
Treatment Outcome
United States