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Cost Analysis of Robotic Versus Open Radical Cystectomy for Bladder Cancer

2009; Lippincott Williams & Wilkins; Volume: 183; Issue: 2 Linguagem: Inglês

10.1016/j.juro.2009.09.081

1527-3792

Angela Smith, Raj Kurpad, Anjana Lal, Matthew E. Nielsen, Eric Wallen, Raj S. Pruthi,

Renal cell carcinoma treatment

No AccessJournal of UrologyAdult Urology1 Feb 2010Cost Analysis of Robotic Versus Open Radical Cystectomy for Bladder Canceris accompanied byRobotic Cystectomy: Its Time Has Come Angela Smith, Raj Kurpad, Anjana Lal, Matthew Nielsen, Eric M. Wallen, and Raj S. Pruthi Angela SmithAngela Smith More articles by this author , Raj KurpadRaj Kurpad More articles by this author , Anjana LalAnjana Lal More articles by this author , Matthew NielsenMatthew Nielsen More articles by this author , Eric M. WallenEric M. Wallen More articles by this author , and Raj S. PruthiRaj S. Pruthi More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2009.09.081AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Recently robotic approaches to cystectomy have been reported, and while clinical and oncological efficacy continues to be evaluated, potential financial costs have not been clearly evaluated. In this study we present a financial analysis using current cost structures and clinical outcomes for robotic and open cystectomy for bladder cancer. Materials and Methods: The financial costs of robotic and open radical cystectomy were categorized into operating room and hospital components, and further divided into fixed and variable costs for each. Fixed operating room costs for open cases involved base cost as well as disposable equipment costs while robotic fixed costs included the amortized machine cost as well as equipment and maintenance. Variable operating room costs were directly related to length of surgery. Variable hospital costs were directly related to transfusion requirement and length of stay. The means of the prior 20 cases of robotic and open cystectomy were used to perform a comparative cost analysis. Results: Mean fixed operating room costs for robotic cases were $1,634 higher than for open cases. Operating room variable costs were also higher by a difference of $570, directly related to increased operating room time. Hospital costs were nearly identical for the fixed component while variable costs were $564 higher for the open approach secondary to higher transfusion costs and longer mean length of stay. Based on these findings robotic cystectomy is associated with an overall higher financial cost of $1,640 (robotic $16,248 vs open $14,608). Cost calculators were constructed based on these fixed and variable costs for each surgical approach to demonstrate the expected total costs based on varying operating room time and length of stay. Conclusions: Robotic assisted laparoscopic radical cystectomy is associated with a higher financial cost (+$1,640) than the open approach in the perioperative setting. However, this analysis is limited by its single institution design and a multicenter followup study is required to provide a more comprehensive analysis. References 1 : Comparative analysis of early perioperative outcomes following radical cystectomy by either the robotic or open method. JSLS2006; 10: 145. Google Scholar 2 : Radical cystectomy with ileal conduit diversion: early prospective evaluation of the impact of robotic assistance. BJU Int2006; 98: 1059. Google Scholar 3 : Robotic assisted laparoscopic radical cystoprostatectomy: operative and pathological outcomes. J Urol2007; 178: 814. 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Link, Google Scholar Division of Urologic Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina© 2010 by American Urological AssociationFiguresReferencesRelatedDetailsCited ByHussein A, May P, Jing Z, Ahmed Y, Wijburg C, Canda A, Dasgupta P, Shamim Khan M, Menon M, Peabody J, Hosseini A, Kelly J, Mottrie A, Kaouk J, Hemal A, Wiklund P and Guru K (2018) Outcomes of Intracorporeal Urinary Diversion after Robot-Assisted Radical Cystectomy: Results from the International Robotic Cystectomy ConsortiumJournal of Urology, VOL. 199, NO. 5, (1302-1311), Online publication date: 1-May-2018.Casella D, Fox J, Schneck F, Cannon G and Ost M (2018) Cost Analysis of Pediatric Robot-Assisted and Laparoscopic PyeloplastyJournal of Urology, VOL. 189, NO. 3, (1083-1086), Online publication date: 1-Mar-2013.Davis J, Gaston K, Anderson R, Dinney C, Grossman H, Munsell M and Kamat A (2018) Robot Assisted Extended Pelvic Lymphadenectomy at Radical Cystectomy: Lymph Node Yield Compared With Second Look Open DissectionJournal of Urology, VOL. 185, NO. 1, (79-84), Online publication date: 1-Jan-2011.Related articlesJournal of UrologyDec 14, 2009, 12:00:00 AMRobotic Cystectomy: Its Time Has Come Volume 183Issue 2February 2010Page: 505-509 Advertisement Copyright & Permissions© 2010 by American Urological AssociationKeywordsroboticsurinary bladder neoplasmscystectomycosts and cost analysisMetricsAuthor Information Angela Smith More articles by this author Raj Kurpad More articles by this author Anjana Lal More articles by this author Matthew Nielsen More articles by this author Eric M. 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