title: Robot-assisted surgery for kidney cancer increased access to a procedure that can reduce mortality and renal failure.
abstract: Surgeons increasingly use robot-assisted minimally invasive surgery for a variety of medical conditions. For hospitals, the acquisition and maintenance of a robot requires a significant investment, but financial returns are not linked to any improvement in long-term patient outcomes in the current reimbursement environment. Kidney cancer provides a useful case study for evaluating the long-term value that this innovation can provide. Kidney cancer is generally treated through partial or radical nephrectomy, with evidence favoring the former procedure for appropriate patients. We found that robot-assisted surgery increased access to partial nephrectomy and that partial nephrectomy reduced mortality and renal failure. The value of the benefits of robot-assisted minimally invasive surgery to patients, in terms of quality-adjusted life-years gained, outweighed the health care and surgical costs to patients and payers by a ratio of five to one. In addition, we found no evidence that the availability of robot-assisted minimally invasive surgery increased the likelihood that inappropriate patients received partial nephrectomy.
authors: Amitabh Chandra (amitabh_chandra@harvard.edu) is a professor of public policy at the John F. Kennedy School of Government, Harvard University, in Cambridge, Massachusetts.
authors: Amitabh
authors: A
authors: Chandra
authors: Julia Thornton Snider is a senior research economist at Precision Health Economics in Los Angeles, California.
authors: Julia Thornton
authors: JT
authors: Snider
authors: Yanyu Wu is an associate research economist, health analytics, at Precision Health Economics in Boston, Massachusetts.
authors: Yanyu
authors: Y
authors: Wu
authors: Anupam Jena is an assistant professor of health care policy and medicine at Harvard Medical School and a physician at Massachusetts General Hospital, both in Boston; and a faculty research fellow at the National Bureau of Economic Research in Cambridge, Massachusetts.
authors: Anupam
authors: A
authors: Jena
authors: Dana P. Goldman is the Leonard D. Schaeffer Chair and director of the Schaeffer Center for Health Policy and Economics at the University of Southern California, in Los Angeles.
authors: Dana P
authors: DP
authors: Goldman
mesh_terms: D000368:Aged; D003362:Cost-Benefit Analysis; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality / Q000601:surgery*; D006278:Medicare / Q000191:economics / Q000706:statistics & numerical data; D019060:Minimally Invasive Surgical Procedures / Q000191:economics / Q000295:instrumentation / Q000379:methods; D009392:Nephrectomy / Q000191:economics / Q000379:methods* / Q000401:mortality; D010043:Outcome and Process Assessment, Health Care / Q000191:economics / Q000706:statistics & numerical data; D019057:Quality-Adjusted Life Years; D051437:Renal Insufficiency / Q000517:prevention & control*; D065287:Robotic Surgical Procedures / Q000191:economics / Q000401:mortality / Q000706:statistics & numerical data*; D018426:SEER Program / Q000706:statistics & numerical data; D016019:Survival Analysis; D013995:Time; D014481:United States / Q000453:epidemiology
keywords: Access To Care; Cost of Health Care; Health Economics; Medical technology; Medicare