title: Cost-analysis of robotic-assisted laparoscopic hysterectomy versus total abdominal hysterectomy for women with endometrial cancer and atypical complex hyperplasia.
abstract: BACKGROUND
  The aim of this study was to analyse the hospital cost of treatment with robotic-assisted laparoscopic hysterectomy and total abdominal hysterectomy for women with endometrial cancer or atypical complex hyperplasia and to identify differences in resource use and cost.
  
  
  METHODS
  This cost analysis was based on two cohorts: women treated with robotic-assisted laparoscopic hysterectomy (n = 202) or with total abdominal hysterectomy (n = 158) at Copenhagen University Hospital, Herlev, Denmark. We conducted an activity-based cost analysis including consumables and healthcare professionals' salaries. As cost-drivers we included severe complications, duration of surgery, anesthesia and stay at the post-anesthetic care unit, as well as number of hospital bed-days. Ordinary least-squares regression was used to explore the cost variation. The primary outcome was cost difference in Danish kroner between total abdominal hysterectomy and robotic-assisted laparoscopic hysterectomy.
  
  
  RESULTS
  The average cost of consumables was 12,642 Danish kroner more expensive per patient for robotic-assisted laparoscopic hysterectomy than for total abdominal hysterectomy (2014 price level: 1€ = 7.50 Danish kroner). When including all cost-drivers, the analysis showed that the robotic-assisted laparoscopic hysterectomy procedure was 9386 Danish kroner (17%) cheaper than the total abdominal hysterectomy (p = 0.003). When the robot investment was included, the cost difference reduced to 4053 Danish kroner (robotic-assisted laparoscopic hysterectomy was 7% cheaper than total abdominal hysterectomy) (p = 0.20). Increasing age and Type 2 diabetes appeared to influence the overall costs.
  
  
  CONCLUSIONS
  For women with endometrial cancer or atypical complex hyperplasia, robotic-assisted laparoscopic hysterectomy was cheaper than total abdominal hysterectomy, mostly due to fewer complications and shorter length of hospital stay.
authors.affiliation: Research Unit in the Department of Anesthesiology, Copenhagen University Hospital, Herlev, Denmark.
authors.forename: Suzanne F
authors.identifier: http://orcid.org/0000-0002-4109-239X
authors.initials: SF
authors.lastname: Herling
authors.affiliation: Department of Gynecology, Copenhagen University Hospital, Herlev, Denmark.
authors.forename: Connie
authors.identifier: http://orcid.org/0000-0003-2299-1143
authors.initials: C
authors.lastname: Palle
authors.affiliation: Research Unit in the Department of Anesthesiology, Copenhagen University Hospital, Herlev, Denmark.
authors.forename: Ann M
authors.identifier: http://orcid.org/0000-0003-1852-1544
authors.initials: AM
authors.lastname: Møller
authors.affiliation: Abdominal Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Thordis
authors.identifier: http://orcid.org/0000-0003-3517-7722
authors.initials: T
authors.lastname: Thomsen
authors.affiliation: Center of Health Economics Research (COHERE), Department of Public Health, University of Southern Denmark, Odense, Denmark.
authors.forename: Jan
authors.identifier: http://orcid.org/0000-0003-0857-9267
authors.initials: J
authors.lastname: Sørensen
mesh_terms: D000005:Abdomen / Q000601:surgery; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000758:Anesthesia / Q000191:economics; D003718:Denmark; D003924:Diabetes Mellitus, Type 2 / Q000191:economics; D004180:Direct Service Costs / Q000706:statistics & numerical data; D004209:Disposable Equipment / Q000191:economics; D004714:Endometrial Hyperplasia / Q000601:surgery*; D016889:Endometrial Neoplasms / Q000601:surgery*; D004865:Equipment and Supplies, Hospital / Q000191:economics; D005260:Female; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D007044:Hysterectomy / Q000191:economics* / Q000379:methods; D007902:Length of Stay / Q000191:economics; D008875:Middle Aged; D061646:Operative Time; D010359:Patient Readmission / Q000191:economics; D010564:Personnel, Hospital / Q000191:economics; D011183:Postoperative Complications / Q000191:economics*; D011997:Recovery Room / Q000191:economics; D065287:Robotic Surgical Procedures / Q000191:economics*; D012456:Salaries and Fringe Benefits / Q000191:economics
keywords: Robotics; costs and cost analysis; economics; endometrial neoplasms; hysterectomy; medical; postoperative complications