Cost-effectiveness analysis of robotically assisted laparoscopy for newly diagnosed uterine cancers.
OBJECTIVE
To assess the direct costs of three surgical approaches in uterine cancer and the cost-effectiveness of incorporating robot-assisted surgery.


METHODS
A cost system that allocates the actual cost of resources used to treat each patient, as opposed to borrowing cost data from a billing system, was used to determine direct costs for patients who underwent surgery for uterine cancer from 2009 to 2010. These costs included all aspects of surgical care up to 6 months after discharge. Total amortized direct costs included the capital cost of three dual-console robotic platforms with 5 years of service contracts. Nonamortized costs were also calculated (excluded capital costs). Modeling was performed to estimate the mean cost of surgical care for patients presenting with endometrial cancer from 2007 to 2010.


RESULTS
Of 436 cases (132 laparoscopic, 262 robotic, 42 laparotomy), total mean amortized direct costs per case were $20,489 (laparoscopy), $23,646 (robot), and $24,642 (laparotomy) (P<.05 [robot compared with laparoscopy]; P=.6 [robot compared with laparotomy]). Total nonamortized costs per case were $20,289, $20,467, and $24,433, respectively (P=.9 [robot compared with laparoscopy]; P=.03 [robot compared with laparotomy]). The planned surgical approach in 2007 was laparoscopy, 68%; robot, 8%; and laparotomy, 24% compared with 26%, 64%, and 9%, respectively, in 2010 (P<.001). The modeled mean amortized direct costs per case were $21,738 in 2007 and $22,678 in 2010 (+$940). Nonamortized costs were $21,298 in 2007 and $20,573 in 2010 (-$725).


CONCLUSIONS
Laparoscopy is least expensive when including capital acquisition costs. Laparoscopy and robotic surgery are comparable if upfront costs are excluded. There is cost neutralization with the robot when it helps decrease laparotomy rates.
Gynecology Service, Department of Surgery, Strategic Planning and Innovation, Quantitative Analysis and Strategic Initiatives, and the Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York.
Mario M
MM
Leitao
Aleksandra
A
Bartashnik
Isaac
I
Wagner
Stephen J
SJ
Lee
Ari
A
Caroline
William J
WJ
Hoskins
Howard T
HT
Thaler
Nadeem R
NR
Abu-Rustum
Yukio
Y
Sonoda
Carol L
CL
Brown
Elizabeth L
EL
Jewell
Richard R
RR
Barakat
Ginger J
GJ
Gardner
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D004180:Direct Service Costs; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000191:economics*; D008875:Middle Aged; D018803:Models, Economic; D012371:Robotics / Q000191:economics*; D013523:Surgical Equipment / Q000191:economics; D014594:Uterine Neoplasms / Q000601:surgery*