title: Cost differences among robotic, vaginal, and abdominal hysterectomy.
abstract: OBJECTIVE
  To compare the costs of vaginal and abdominal hysterectomy with robotically assisted hysterectomy.
  
  
  METHODS
  We identified all cases of robotically assisted hysterectomy, with or without bilateral salpingo-oophorectomy, treated at the Mayo Clinic (Rochester, Minnesota) from January 1, 2007, through December 31, 2009. Cases were propensity score-matched (one-to-one) to cases of vaginal and abdominal hysterectomy, selected randomly from January 1, 2004, through December 31, 2006 (before acquisition of the robotic surgical system). All billed costs were abstracted through the sixth postoperative week from the Olmsted County Healthcare Expenditure and Utilization Database and compared between cohorts with a generalized linear modeling framework. Predicted costs were estimated with the recycled predictions method. Costs of operative complications also were estimated.
  
  
  RESULTS
  The total number of abdominal hysterectomies collected for comparison was 234 and the total number of vaginal hysterectomies was 212. Predicted mean cost of robotically assisted hysterectomy was $2,253 more than that of vaginal hysterectomy ($13,619 compared with $11,366; P<.001), although costs of complications were not significantly different. The predicted mean costs of robotically assisted compared with abdominal hysterectomy were similar ($14,679 compared with $15,588; P=.35). The costs of complications were not significantly different.
  
  
  CONCLUSIONS
  Overall, vaginal hysterectomy was less costly than robotically assisted hysterectomy. Abdominal hysterectomy and robotically assisted hysterectomy had similar costs.
  
  
  METHODS
  II.
authors.affiliation: Urogynecology and Continence Center, Methodist Physicians Clinic, Omaha, Nebraska; and the Divisions of Health Care Policy and Research and Gynecologic Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Joshua L
authors.initials: JL
authors.lastname: Woelk
authors.forename: Bijan J
authors.initials: BJ
authors.lastname: Borah
authors.forename: Emanuel C
authors.initials: EC
authors.lastname: Trabuco
authors.forename: Herbert C
authors.initials: HC
authors.lastname: Heien
authors.forename: John B
authors.initials: JB
authors.lastname: Gebhart
mesh_terms: D000328:Adult; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects / Q000191:economics* / Q000379:methods*; D007045:Hysterectomy, Vaginal / Q000009:adverse effects / Q000191:economics / Q000706:statistics & numerical data; D007431:Intraoperative Complications / Q000191:economics / Q000453:epidemiology; D007902:Length of Stay / Q000191:economics; D008875:Middle Aged; D008910:Minnesota; D010052:Ovariectomy / Q000191:economics; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology; D012371:Robotics / Q000191:economics* / Q000706:statistics & numerical data; D058994:Salpingectomy / Q000191:economics