Cost comparison among robotic, laparoscopic, and open hysterectomy for endometrial cancer.
OBJECTIVE
To use decision modeling to compare the costs associated with robotic, laparoscopic, and open hysterectomy for the treatment of endometrial cancer.


METHODS
Three separate models were used, each with sensitivity analysis: 1) a societal perspective model, which included inpatient hospital costs, robotic expenses, and lost wages and caregiver costs; 2) a hospital perspective plus robot costs model, which was identical to the societal perspective model but excluded lost wages and caregiver costs; and 3) a hospital perspective without robot costs model, which was identical to the hospital perspective plus robot costs model except that it excluded initial cost of the robot.


RESULTS
The societal perspective model predicted laparoscopy ($10,128) as the least expensive approach followed by robotic and ($11,476) and open hysterectomy ($12,847). Societal perspective model sensitivity analyses predicted robotic hysterectomy to be least expensive when robotic disposable equipment cost less than $1,046 per case (baseline cost $2,394). In the hospital perspective plus robot costs model, laparoscopy was least expensive ($6,581) followed by open ($7,009) and robotic hysterectomy ($8,770); however, if hospital stay after open surgery was less than 2.9 days, open hysterectomy was least expensive. In the hospital perspective without robot costs model, laparoscopy remained least expensive, but robotic surgery became least expensive if the cost of robotic disposable equipment was reduced to less than $1,496 per case.


CONCLUSIONS
Laparoscopy is the least expensive surgical approach for the treatment of endometrial cancer. Robotic is less costly than abdominal hysterectomy when the societal costs associated with recovery time are accounted for and is most economically attractive if disposable equipment costs can be minimized.


METHODS
III.
Barnett
Jason C
JC
From the Divisions of Gynecologic Oncology and Urogynecology, the Department of Obstetrics and Gynecology, and the Division of Urology, Department of Surgery, Duke University, Durham, North Carolina; and the Division of Clinical and Epidemiological Research Duke University, Durham, North Carolina.
Judd
John P
JP
Wu
Jennifer M
JM
Scales
Charles D
CD
Myers
Evan R
ER
Havrilesky
Laura J
LJ
D003661:Decision Support Techniques; D016889:Endometrial Neoplasms / Q000191:economics / Q000601:surgery*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000191:economics*; D010535:Laparoscopy / Q000191:economics*; D018803:Models, Economic; D012371:Robotics / Q000191:economics*