Cost-Effectiveness of Conventional vs Robotic-Assisted Laparoscopy in Gynecologic Oncologic Indications. Marino, P.; Houvenaeghel, G.; Narducci, F.; Boyer-Chammard, A.; Ferron, G.; Uzan, C.; Bats, A. S.; Mathevet, P.; Dessogne, P.; Guyon, F.; Rouanet, P.; Jaffre, I.; Carcopino, X.; Perez, T.; and Lambaudie, E. Int J Gynecol Cancer, 25(6):1102–8, July, 2015.
Cost-Effectiveness of Conventional vs Robotic-Assisted Laparoscopy in Gynecologic Oncologic Indications [link]Paper  doi  abstract   bibtex   
OBJECTIVE: Robotic surgical techniques are known to be expensive, but they can decrease the cost of hospitalization and improve patients' outcomes. The aim of this study was to compare the costs and clinical outcomes of conventional laparoscopy vs robotic-assisted laparoscopy in the gynecologic oncologic indications. METHODS: Between 2007 and 2010, 312 patients referred for gynecologic oncologic indications (endometrial and cervical cancer), including 226 who underwent conventional laparoscopy and 80 who underwent robot-assisted laparoscopy, were included in this prospective multicenter study. The direct costs, operating theater costs, and hospital costs were calculated for both surgical strategies using the microcosting method. RESULTS: Based on an average number of 165 surgical cases performed per year with the robot, the total extra cost of using the robot was euro1456 per intervention. The robot-specific costs amounted to euro2213 per intervention, and the cost of the robot-specific surgical supplies was euro957 per intervention. The cost of the surgical supplies specifically required by conventional laparoscopy amounted to euro1432, which is significantly higher than that of the robotic supplies (P \textless 0.001). Hospital costs were lower in the case of the robotic strategy (euro2380 vs euro2841, P \textless 0.001) because these patients spent less time in intensive care (0.38 vs 0.85 days). Operating theater costs were higher in the case of the robotic strategy (euro1490 vs euro1311, P = 0.0004) because the procedure takes longer to perform (4.98 hours vs 4.38 hours). CONCLUSIONS: The main driver of additional costs is the fixed cost of the robot, which is not compensated by the lower hospital room costs. The robot would be more cost-effective if robotic interventions were performed on a larger number of patients per year or if the purchase price of the robot was reduced. A shorter learning curve would also no doubt decrease the operating theater costs, resulting in financial benefits to society.
@article{marino_cost-effectiveness_2015,
	title = {Cost-{Effectiveness} of {Conventional} vs {Robotic}-{Assisted} {Laparoscopy} in {Gynecologic} {Oncologic} {Indications}},
	volume = {25},
	issn = {1525-1438 (Electronic) 1048-891X (Linking)},
	shorttitle = {Cost-{Effectiveness} of {Conventional} vs {Robotic}-{Assisted} {Laparoscopy} in {Gynecologic} {Oncologic} {Indications}},
	url = {http://www.ncbi.nlm.nih.gov/pubmed/26098092},
	doi = {10.1097/IGC.0000000000000458},
	abstract = {OBJECTIVE: Robotic surgical techniques are known to be expensive, but they can decrease the cost of hospitalization and improve patients' outcomes. The aim of this study was to compare the costs and clinical outcomes of conventional laparoscopy vs robotic-assisted laparoscopy in the gynecologic oncologic indications. METHODS: Between 2007 and 2010, 312 patients referred for gynecologic oncologic indications (endometrial and cervical cancer), including 226 who underwent conventional laparoscopy and 80 who underwent robot-assisted laparoscopy, were included in this prospective multicenter study. The direct costs, operating theater costs, and hospital costs were calculated for both surgical strategies using the microcosting method. RESULTS: Based on an average number of 165 surgical cases performed per year with the robot, the total extra cost of using the robot was euro1456 per intervention. The robot-specific costs amounted to euro2213 per intervention, and the cost of the robot-specific surgical supplies was euro957 per intervention. The cost of the surgical supplies specifically required by conventional laparoscopy amounted to euro1432, which is significantly higher than that of the robotic supplies (P {\textless} 0.001). Hospital costs were lower in the case of the robotic strategy (euro2380 vs euro2841, P {\textless} 0.001) because these patients spent less time in intensive care (0.38 vs 0.85 days). Operating theater costs were higher in the case of the robotic strategy (euro1490 vs euro1311, P = 0.0004) because the procedure takes longer to perform (4.98 hours vs 4.38 hours). CONCLUSIONS: The main driver of additional costs is the fixed cost of the robot, which is not compensated by the lower hospital room costs. The robot would be more cost-effective if robotic interventions were performed on a larger number of patients per year or if the purchase price of the robot was reduced. A shorter learning curve would also no doubt decrease the operating theater costs, resulting in financial benefits to society.},
	number = {6},
	journal = {Int J Gynecol Cancer},
	author = {Marino, P. and Houvenaeghel, G. and Narducci, F. and Boyer-Chammard, A. and Ferron, G. and Uzan, C. and Bats, A. S. and Mathevet, P. and Dessogne, P. and Guyon, F. and Rouanet, P. and Jaffre, I. and Carcopino, X. and Perez, T. and Lambaudie, E.},
	month = jul,
	year = {2015},
	keywords = {Adult, Aged, Female, Follow-Up Studies, Humans, Middle Aged, Aged, 80 and over, Prognosis, Prospective Studies, Lymphatic Metastasis, Neoplasm Staging, *Postoperative Complications, Length of Stay, *Cost-Benefit Analysis, Endometrial Neoplasms/*economics/pathology/surgery, Laparoscopy/*economics, Pelvic Neoplasms/*economics/secondary/surgery, Robotic Surgical Procedures/*economics, ROC Curve, Uterine Cervical Neoplasms/*economics/pathology/surgery},
	pages = {1102--8}
}
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