ERUS 2018: Costs of Robotic Surgery in the Current Medical Context: Urology vs. Radiotherapy, vs. Radiology vs. Nuclear Medicine vs. Medical Oncology

Marseille, France ( Dr. Naeyer discussed the topic of costs of robotic surgery compared to other treatments. There has been an exponential increase in the costs of robotic surgery since its first introduction in the 1990s (Figure 1). The cost of the daVinci surgical system is quite high, with a very high initial investment. The Si system costs 1 million Euro and the Xi system dual console costs 2 million Euro. Moreover, the maintenance costs are high as well, with prices ranging from 150000-200000 Euro per year, and 1500 Euros per procedure. Comparison between robotic and open radical prostatectomy have shown that the direct costs for robotic cases are substantially higher.

In Ontario, Canada, Health Quality Ontario has concluded that the cost of using the robotic surgical system is relatively high, while the health benefit is relatively small. Therefore, it had stated that robotic prostatectomy does not appear to be cost-effective in patients with clinically localized prostate cancer.

UroToday ERUS2018 Increase in costs of robotic surgery over the years
Figure 1 – Increase in costs of robotic surgery over the years The high costs for robotic surgery include the initial investment in acquiring the robotic system, the instruments, the maintenance, the OR time, the conversion, complications, length of hospital stay, readmissions, surgeon workload, return to work, and quality of life.

Dr. Naeyer moved on to discuss the costs of other treatment in comparison to the cost of robotic surgery. He began with the costs of radiology innovations, demonstrating that the different radiotherapy modalities are quite expensive as well. Furthermore, innovations in this field with the integration of imaging modalities such as MRI with the treating unit, are extremely expensive, with costs of up to 4000-10000 Euro.  Fiducial markers used in radiotherapy are approximately 300 Euros per case.

He moved on to discuss the costs of medical treatment of castrate-resistant prostate cancer. The treatment for enzalutamide costs approximately 7500 $ per month, and with an average treatment course of 8 months, it sums up to a total of 60000$ per patient. Similarly, Abiraterone costs approximately 5000 $ per months with an average treatment course of eight months, summing up to a total cost of 40000 $ per patient. The costs for Radium 223 are quite high as well. Following the publications demonstrating the benefit of abiraterone in the setting of hormone-sensitive prostate cancer, the cost for this treatment per patient will only continue to rise.

It is important to remember that the percentage of the population for which a drug is ineffective, is quite high. For example, 38% of antidepressants, 40% of anti-asthma drugs, 43% of diabetes drugs, 70% of Alzheimer’s drugs, and 75% of cancer drugs, are ineffective.

Dr. Naeyer summarized his talk by stating that the costs, cost-effectiveness and cost comparisons are difficult to measure. Robotic surgery is expensive, but relative to other treatments it is quite cheap. We need more accurate ways of capturing costs and outcomes of new treatments. Finally, as urologists, we need to stay involved in these discussions and be involved in the adaptation of new technologies in healthcare systems.

Presented by: G. De Naeyer, Aalst, Belgium

Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre, Twitter:@GoldbergHanan at the EAU Robotic Urology Section (ERUS) Meeting - September 5 - 7, 2018 - Marseille, France