title: Cost-analysis comparison of robot-assisted laparoscopic radical cystectomy (RC) vs open RC.
abstract: OBJECTIVE
  • To systematically review and compare the economic burden of open radical cystectomy (ORC) vs robot-assisted laparoscopic radical cystectomy (RALRC) with pelvic lymph node dissection and urinary diversion.
  
  
  METHODS
  • A Medline search was conducted to identify English language articles regarding RC with urinary diversion. The resulting articles were then further restricted by the terms 'laparoscopic', 'robotic', or 'robotic-assisted'.In all, three articles were identified. • Data from each of these articles were then collected on cost performance in addition to relevant clinical variables, such as length of stay (LOS), operative duration, and complication rates. • When possible, data were subdivided by ileal conduit (IC), continent cutaneous diversion (CCD), and orthotopic neobladder (ON) subgroups. • Direct costs resulting from ORC or RALRC with accompanying hospitalization were identified. The indirect costs of complications were considered.
  
  
  RESULTS
  • Despite an increased materials cost, RALRC was less expensive than ORC when the cost of complications was considered. • RALRC was less expensive than ORC for IC and CCD, but the cost advantage deteriorated for ON. • The largest cost drivers cited in the published data were LOS, operative durations, and daily hospitalizations costs. • RALRC demonstrated shorter LOS compared with ORC, although this effect was insufficient to offset the increased cost of robotic surgery. • Complications materially affected cost performance.
  
  
  CONCLUSIONS
  • Despite an increased materials cost, RALRC can be more cost efficient than ORC as a treatment for bladder cancer when the impact of complications are considered. • This effect is most pronounced for patients undergoing IC.
authors.affiliation: James Buchanan Brady Foundation, Department of Urology, Weill Medical College of Cornell University, New York, NY 10065, USA. ril9010@med.cornell.edu
authors.forename: Richard
authors.initials: R
authors.lastname: Lee
authors.forename: Bilal
authors.initials: B
authors.lastname: Chughtai
authors.forename: Michael
authors.initials: M
authors.lastname: Herman
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Scherr
mesh_terms: D003365:Costs and Cost Analysis; D015653:Cystectomy / Q000191:economics* / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000191:economics* / Q000379:methods; D008197:Lymph Node Excision / Q000191:economics*; D019060:Minimally Invasive Surgical Procedures / Q000191:economics / Q000379:methods; D012371:Robotics / Q000191:economics*; D025321:Surgery, Computer-Assisted / Q000191:economics / Q000379:methods; D001743:Urinary Bladder / Q000601:surgery; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D014547:Urinary Diversion / Q000191:economics* / Q000379:methods