title: Robot-assisted versus open sacrocolpopexy: a cost-minimization analysis.
abstract: OBJECTIVE
  Abdominal sacrocolpopexy is considered a standard of care operation for apical vaginal vault prolapse repair. Using outcomes at our center we evaluated whether the robotic approach to sacrocolpopexy is as cost-effective as the open approach.
  
  
  METHODS
  After obtaining institutional review board approval we performed cost-minimization analysis in a retrospective cohort of patients who underwent sacrocolpopexy at our institution between 2006 and 2010. Threshold values, that is model variable values at which the most cost effective approach crosses over to an alternative approach, were determined by testing model variables over realistic ranges using sensitivity analysis. Hospital billing data were also evaluated to confirm our findings.
  
  
  RESULTS
  Operative time was similar for robotic and open surgery (226 vs 221 minutes) but postoperative length of stay differed significantly (1.0 vs 3.3 days, p <0.001). Base case analysis revealed an overall 10% cost savings for robot-assisted vs open sacrocolpopexy ($10,178 vs $11,307). Tornado analysis suggested that the number of institutional robotic cases done annually, length of stay and cost per hospitalization day in the postoperative period were the largest drivers of cost. Analysis of our hospital billing data showed a similar trend with robotic surgery costing 4.2% less than open surgery.
  
  
  CONCLUSIONS
  A robot-assisted approach to sacrocolpopexy can be equally or less costly than an open approach. This depends on a sufficient institutional robotic case volume and a shorter postoperative stay for patients who undergo the robot-assisted procedure.
authors.affiliation: Stanford University, Stanford, CA, USA.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Elliott
authors.forename: Michael H
authors.initials: MH
authors.lastname: Hsieh
authors.forename: Eric R
authors.initials: ER
authors.lastname: Sokol
authors.forename: Craig V
authors.initials: CV
authors.lastname: Comiter
authors.forename: Christopher K
authors.initials: CK
authors.lastname: Payne
authors.forename: Bertha
authors.initials: B
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D003365:Costs and Cost Analysis; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000191:economics / Q000379:methods; D006801:Humans; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D012189:Retrospective Studies; D012371:Robotics / Q000191:economics*