title: A comparative direct cost analysis of pediatric urologic robot-assisted laparoscopic surgery versus open surgery: could robot-assisted surgery be less expensive?
abstract: OBJECTIVE
  Cost in healthcare is an increasing and justifiable concern that impacts decisions about the introduction of new devices such as the da Vinci(®) surgical robot. Because equipment expenses represent only a portion of overall medical costs, we set out to make more specific cost comparisons between open and robot-assisted laparoscopic surgery.
  
  
  METHODS
  We performed a retrospective, observational, matched cohort study of 146 pediatric patients undergoing either open or robot-assisted laparoscopic urologic surgery from October 2004 to September 2009 at a single institution. Patients were matched based on surgery type, age, and fiscal year. Direct internal costs from the institution were used to compare the two surgery types across several procedures.
  
  
  RESULTS
  Robot-assisted surgery direct costs were 11.9% (P=0.03) lower than open surgery. This cost difference was primarily because of the difference in hospital length of stay between patients undergoing open vs robot-assisted surgery (3.8 vs 1.6 days, P<0.001). Maintenance fees and equipment expenses were the primary contributors to robotic surgery costs, while open surgery costs were affected most by room and board expenses. When estimates of the indirect costs of robot purchase and maintenance were included, open surgery had a lower total cost. There were no differences in follow-up times or complication rates.
  
  
  CONCLUSIONS
  Direct costs for robot-assisted surgery were significantly lower than equivalent open surgery. Factors reducing robot-assisted surgery costs included: A consistent and trained robotic surgery team, an extensive history of performing urologic robotic surgery, selection of patients for robotic surgery who otherwise would have had longer hospital stays after open surgery, and selection of procedures without a laparoscopic alternative. The high indirect costs of robot purchase and maintenance remain major factors, but could be overcome by high surgical volume and reduced prices as competitors enter the market.
authors.affiliation: Robotic Surgery, Research and Training Center, Department of Urology, Children's Hospital, Boston, Massachusetts 02115, USA.
authors.forename: Courtney K
authors.initials: CK
authors.lastname: Rowe
authors.forename: Michael W
authors.initials: MW
authors.lastname: Pierce
authors.forename: Katherine C
authors.initials: KC
authors.lastname: Tecci
authors.forename: Constance S
authors.initials: CS
authors.lastname: Houck
authors.forename: James
authors.initials: J
authors.lastname: Mandell
authors.forename: Alan B
authors.initials: AB
authors.lastname: Retik
authors.forename: Hiep T
authors.initials: HT
authors.lastname: Nguyen
mesh_terms: D002648:Child; D003365:Costs and Cost Analysis; D003710:Demography; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000191:economics* / Q000379:methods*; D008297:Male; D011183:Postoperative Complications / Q000191:economics / Q000209:etiology; D012371:Robotics / Q000191:economics* / Q000379:methods*; D013520:Urologic Surgical Procedures / Q000009:adverse effects / Q000191:economics* / Q000379:methods*