title: Regional Cost Variations of Robot-Assisted Radical Prostatectomy Compared With Open Radical Prostatectomy.
abstract: BACKGROUND
  The purpose of the study was to evaluate the cost differences between robot-assisted radical prostatectomy (RARP) and open radical prostatectomy (ORP) in various census regions of the United States because RARP has been reported to be more expensive than ORP with significant regional cost variations in radical prostatectomy (RP) cost across the United States.
  
  
  METHODS
  International Classification of Diseases, Ninth Revision, Clinical Modification codes were used to identify patients with prostate cancer who underwent RARP or ORP from the Nationwide Inpatient Sample (NIS) database from 2009 to 2011. Hospital costs were compared using the Wilcoxon rank sum test and multivariable linear regression analysis adjusting for age, sex, race, comorbidities, and hospital characteristics.
  
  
  RESULTS
  From the NIS database, 24,636 RARP and 13,590 ORP procedures were identified and evaluated. The lowest cost overall was in the South; the highest cost RARP was in the West and for ORP in the Northeast. In multivariable analysis, adjusted according to patient and hospital characteristics, RARP was 43.3% more costly in the Midwest, 37.2% more costly in the South, and 39.1% more costly in the West (P < .0001 for all). In contrast, the cost for RARP in the Northeast was 12.8% less than for ORP (P < .0001).
  
  
  CONCLUSIONS
  Cost for RP significantly varies within the nation and in most regions it is significantly greater for RARP than for ORP. ORP in the Northeast is more costly than RARP. Further research is needed to delineate the reason for these differences and to optimize the cost of RP.
authors.affiliation: Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ.
authors.forename: Izak
authors.initials: I
authors.lastname: Faiena
authors.affiliation: Department of Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ.
authors.forename: Viktor Y
authors.initials: VY
authors.lastname: Dombrovskiy
authors.affiliation: Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ.
authors.forename: Parth K
authors.initials: PK
authors.lastname: Modi
authors.affiliation: Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ.
authors.forename: Neal
authors.initials: N
authors.lastname: Patel
authors.affiliation: Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ.
authors.forename: Rutveej
authors.initials: R
authors.lastname: Patel
authors.affiliation: Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ.
authors.forename: Amirali H
authors.initials: AH
authors.lastname: Salmasi
authors.affiliation: Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ.
authors.forename: Jaspreet S
authors.initials: JS
authors.lastname: Parihar
authors.affiliation: Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ.
authors.forename: Eric A
authors.initials: EA
authors.lastname: Singer
authors.affiliation: Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ. Electronic address: kimiy@cinj.rutgers.edu.
authors.forename: Isaac Y
authors.initials: IY
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017722:Hospital Charges / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011468:Prostatectomy / Q000191:economics* / Q000379:methods; D011471:Prostatic Neoplasms / Q000191:economics / Q000601:surgery*; D065287:Robotic Surgical Procedures / Q000191:economics* / Q000379:methods; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult
keywords: Cost; Nationwide inpatient sample; Open prostatectomy; Regional variation; Robotic radical prostatectomy