title: Costs of radical prostatectomy for prostate cancer: a systematic review.
abstract: BACKGROUND
  Robot-assisted laparoscopic radical prostatectomy (RALP) has been rapidly adopted as a new approach for radical prostatectomy (RP) in patients with prostate cancer (PCa). The use of new technology may increase costs for RP.
  
  
  OBJECTIVE
  To summarize data on direct costs of various approaches to RP and to discuss the consequences of cost differences.
  
  
  METHODS
  A systematic literature search was performed in March 2012 using the PubMed, Web of Science, and Cochrane Library databases. A complex search strategy was applied. Articles were selected according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. Articles reporting on direct costs of RP (open retropubic [RRP], radical perineal [RPP], laparoscopic [LRP], RALP) in men with clinically localized PCa were eligible for study inclusion.
  
  
  RESULTS
  Of 1218 articles initially screened by title, the multistep, systematic search identified 11 studies presenting direct costs of different approaches to RP. Of the 11 studies, 7 compared the costs of different RP approaches. Minimally invasive RP (MIRP) (ie, LRP or RALP) was more expensive than RRP in most studies, mainly due to increased surgical instrumentation costs. In the comparative studies, costs ranged from (in US dollars) $5058 to $11,806 for MIRP and from $4075 to $6296 for RRP, with RALP having the highest direct costs. In one study applying standardized, health economic-evaluation criteria, RALP was not found to be cost effective. Limitations of this review include significant differences in observational study designs and an absence of prospective comparative studies. Moreover, there are limited post-RP data on the costs of adjuvant treatments and other health care-related expenses after PCa surgery.
  
  
  CONCLUSIONS
  Few studies compared direct costs of different approaches to RP. The use of new technology, particularly RALP, results in added costs for the procedure. Cost effectiveness of new technologies should be assessed before widespread adoption. To date, in the lone study to evaluate this, RALP was not found to be cost effective from a health care, economic standpoint. However, longer follow-up of patients is required to better evaluate its impact on overall costs and quality of PCa care.
authors.affiliation: Department of Urology, Mannheim Medical Center, University of Heidelberg, Mannheim, Germany. Electronic address: christian.bolenz@umm.de.
authors.forename: Christian
authors.initials: C
authors.lastname: Bolenz
authors.affiliation: Department of Surgery - Durham VA Medical Center, and Departments of Surgery (Urology) and Pathology, Duke University School of Medicine, Durham, NC, USA.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Freedland
authors.affiliation: Division of Oncology, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Brent K
authors.initials: BK
authors.lastname: Hollenbeck
authors.affiliation: University of Texas Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Yair
authors.initials: Y
authors.lastname: Lotan
authors.affiliation: Department of Surgery, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.
authors.forename: William T
authors.initials: WT
authors.lastname: Lowrance
authors.affiliation: University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Joel B
authors.initials: JB
authors.lastname: Nelson
authors.affiliation: David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, USA.
authors.forename: Jim C
authors.initials: JC
authors.lastname: Hu
mesh_terms: D003362:Cost-Benefit Analysis; D017048:Health Care Costs; D006801:Humans; D010535:Laparoscopy / Q000191:economics*; D008297:Male; D011468:Prostatectomy / Q000191:economics* / Q000379:methods; D011471:Prostatic Neoplasms / Q000191:economics* / Q000601:surgery*; D011787:Quality of Health Care / Q000191:economics; D012371:Robotics / Q000191:economics*; D016896:Treatment Outcome