Lower Out-of-Pocket Costs for Robotic Cancer Surgery

By Reuters Staff

January 25, 2020

NEW YORK (Reuters Health) - Out-of-pocket costs for patients undergoing robotic cancer surgery are lower than those for patients undergoing open cancer surgery, according to a database study.

Several earlier studies reported higher direct hospital costs associated with robotic surgery, but little attention has been given to out-of-pocket costs for patients.

Dr. Quoc-Dien Trinh of Brigham and Women's Hospital and Harvard Medical School, in Boston, and colleagues used information from the IBM Watson Health MarketScan Commercial Claims and Encounters database to assess out-of-pocket costs and total payments for five types of common oncologic procedures that can be performed using an open or robotic approach.

The study included 8,260 adult patients who underwent robotic procedures and 7,633 who underwent open procedures. Robotic procedures accounted for 78% of radical prostatectomies, 29% of radical nephrectomies, 60% of partial nephrectomies, 23% of hysterectomies and 13% of partial colectomies.

Compared with open procedures, out-of-pocket costs averaged $138 lower for robotic prostatectomy, $641 lower for robotic hysterectomy, $1,141 lower for robotic partial colectomy, $728 lower for robotic radical nephrectomy, and $303 for robotic partial nephrectomy, the researchers report in JAMA Network Open.

The robotic approach was also associated with lower total payments for all procedures examined, averaging $3,873 lower per radical prostatectomy, $29,641 lower per hysterectomy, $38,152 lower per partial colectomy, $33,394 lower per radical nephrectomy, and $9,163 lower per partial nephrectomy.

The robotic approach was associated with shorter length of stay for all procedures, ranging from 0.94 day shorter for radical prostatectomy to 3.18 days shorter for partial colectomy.

For the entire perioperative period (from 14 days before to 28 days after surgery), adjusted out-of-pocket costs were significantly lower for the robotic option for partial colectomy and radical nephrectomy, but not for the other procedures, and adjusted total payments were significantly lower for all robotic procedures except radical prostatectomy.

The authors caution that these analyses do not account for the costs of procuring and maintaining a robotic system (which can range from $0.5 million to $2.5 million), and that previous analyses have shown that robotic surgery could be more expensive perioperatively than open surgery when the costs of robotic maintenance and disposable instruments are included.

"These results highlight the complexity of economic factors that are associated with the rapid adoption and possible subsidization of the robotic approach for common surgically amenable conditions and lay a foundation for future work on this issue," the authors conclude.

The study did not have commercial funding.

Dr. Trinh, who did not respond to a request for comments, has previously received funding from Intuitive Surgical, which sells surgical robots.

SOURCE: https://bit.ly/38xsYyT JAMA Network Open, online January 15, 2020.