Cost comparison between open radical cystectomy, laparoscopic radical cystectomy, and robot-assisted radical cystectomy for patients with bladder cancer: a systematic review of segmental costs.

Robot-assisted radical cystectomy is becoming a common treatment for bladder carcinoma. However, in comparison with open radical cystectomy, its cost-effectiveness has not been confirmed. Although few published reviews have compared total costs between the two surgical procedures, no study has compared segmental costs and explained their impact on total costs.

A systematic review was conducted based on studies on the segmental costs of open, laparoscopic, and robot-assisted radical cystectomy using PubMed, Web of Science, and Cochrane Library databases to provide insight into cost-effective management methods for radical cystectomy. The segmental costs included operating, robot-related, complication, and length of stay costs. A sensitivity analysis was conducted to determine the impact of the annual number of cases on the per-case robot-related costs.

We identified two studies that compared open and laparoscopic surgeries and nine that compared open and robotic surgeries. Open radical cystectomy costs were higher than those of robotic surgeries in two retrospective single-institution studies, while robot-assisted radical cystectomy costs were higher in 1 retrospective single-institution study, 1 randomized controlled trial, and 4 large database studies. Operating costs were higher for robotic surgery, and accounted for 63.1-70.5% of the total robotic surgery cost. Sensitivity analysis revealed that robot-related costs were not a large proportion of total surgery costs in institutions with a large number of cases but accounted for a large proportion of total costs in centers with a small number of cases.

The results show that robot-assisted radical cystectomy is more expensive than open radical cystectomy. The most effective methods to decrease costs associated with robotic surgery include a decrease in operating time and an increase in the number of cases. Further research is required on the cost-effectiveness of surgeries, including quality measures such as quality of life and quality-adjusted life years.

BMC urology. 2019 Nov 08*** epublish ***

Yasuhiro Morii, Takahiro Osawa, Teppei Suzuki, Nobuo Shinohara, Toru Harabayashi, Tomoki Ishikawa, Takumi Tanikawa, Hiroko Yamashina, Katsuhiko Ogasawara

Graduate school of Health Sciences, Hokkaido University, N12-W5, Kitaku, Sapporo, Hokkaido, Japan., Department of Renal and Genitourinary Surgery Graduate School of Medicine, Hokkaido University, N14, W5, KitaKu, Sapporo, Hokkaido, Japan., Hokkaido University of Education, Art, and Sports Business, Sapporo, Hokkaido, Japan., Department of Urology, Hokkaido Cancer Center, 3-54, Kikusui 4-2, Shiroishiku, Sapporo, Hokkaido, Japan., Faculty of Health Sciences, Hokkaido University, N12-W5, Kitaku, Sapporo, Hokkaido, Japan., Faculty of Health Sciences, Hokkaido University of Science, 7-Jo 15-4-1 Maeda, Teine, Sapporo, Hokkaido, Japan., Faculty of Health Sciences, Hokkaido University, N12-W5, Kitaku, Sapporo, Hokkaido, Japan. .