ERUS 2018: Is Minimal Invasive Surgery Truly Improving Early Return to Work of Patients?

Marseille, France (UroToday.com) Dr. Dasgupta gave a talk on the effect of minimally invasive surgery on the return to work of patients. The cost of robot-assisted procedures rose by 13% in 3 years. This amounts to 2.5 billion dollars in additional healthcare costs.  In an analysis of 630,000 cases in more than ten years of open and robotic radical prostatectomy, it was shown that 104 cases of robotic prostatectomy per year are needed to make it a cost-effective procedure.1

The question of whether robotic prostatectomy has a shorter hospital stay compared to open procedure has been raised and analyzed in the past. The answer to this question depends more on the country where the procedure is done than on the procedure itself. In Germany for instance, the DRG payment per case is given only if a patient stays in the hospital for at least four days, even if he was ready to go home on the very next day. In a systematic review of the cost-effectiveness of robotics in urological surgery, it was shown that reducing the length of hospital stay is not enough to increase its cost-effectiveness.2 In an analysis of the resulting days of absence after prostatectomy performed in various surgical modalities, it was shown that open procedures result in significantly more days of absence than robotic procedures, and even laparoscopic prostatectomy results in more days of absence than robotic procedures.

Societal benefits is another way of looking at the benefits that could be achieved through the usage of robotic procedures in the long run. In a unique analysis (Monte-Carlo analysis), robotic radical prostatectomy demonstrated 33-99% probability of cost savings with 1202$ societal benefits compared to open radical prostatectomy.3 These societal benefits could offset the cost-ineffectiveness of robotic radical prostatectomy in the hospital and should be further explored in the future.


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

References:

  1. Leow JJ, Chang SL, Meyer CP, et al. Robot-assisted Versus Open Radical Prostatectomy: A Contemporary Analysis of an All-payer Discharge Database. European Urology 2016; 70(5): 837-45.
  2. Ahmed K, Ibrahim A, Wang TT, et al. Assessing the cost-effectiveness of robotics in urological surgery - a systematic review. BJU international 2012; 110(10): 1544-56.
  3. Bijlani A, Hebert AE, Davitian M, et al. A Multidimensional Analysis of Prostate Surgery Costs in the United States: Robotic-Assisted versus Retropubic Radical Prostatectomy. Value in health: the journal of the International Society for Pharmacoeconomics and Outcomes Research 2016; 19(4): 391-403.
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