title: Cost-effectiveness of robot-assisted partial nephrectomy for the prevention of perioperative complications.
abstract: OBJECTIVE
  To evaluate the cost-effectiveness of robot-assisted partial nephrectomy (RAPN) and secondarily of laparoscopic PN (LPN) compared to the open procedure.
  
  
  METHODS
  Model-based cost-effectiveness analysis: The model was structured as decision tree. The model was populated with published data. We measured intraoperative, postoperative complications, and inhospital deaths. We expressed costs in US dollars ($).The reference analysis calculated the mean cost and the mean number of each endpoint over 5000 iterations using a second-order Monte Carlo simulation. We conducted extensive sensitivity analyses.
  
  
  RESULTS
  The mean inhospital costs were $13,186 for RAPN, $10,782 for LPN, and $12,539 for open partial nephrectomy (OPN), respectively. The incremental cost to prevent an inhospital event amounted to $5005 for RAPN compared to OPN. Lower RENAL scores were associated with lower incremental cost per avoided complications. Under assumption of 55 % higher costs in patients with complications, RAPN dominated OPN. LPN dominated OPN. We are aware of the following limitations: First, cost data for patients with and without complications were not available and we assumed the median cost for all cases, i.e., the analysis overestimated the cost associated with RAPN; second, we focused on inhospital estimates and did not apply a societal perspective.
  
  
  CONCLUSIONS
  RAPN appears to be a cost-effective mean to avoid inhospital complications; however, these results might not apply to low-volume hospitals or to other health care systems.
authors.affiliation: Department of Urology and Urologic Oncology, Alfried Krupp Krankenhaus, Essen, Germany. stephan.buse@krupp-krankenhaus.de.|Department of Urology and Pediatric Urology, University Hospital of Frankfurt, Frankfurt, Germany. stephan.buse@krupp-krankenhaus.de.
authors.forename: Stephan
authors.initials: S
authors.lastname: Buse
authors.affiliation: Department of Urology and Urologic Oncology, Alfried Krupp Krankenhaus, Essen, Germany.
authors.forename: Carolin E
authors.initials: CE
authors.lastname: Hach
authors.affiliation: Department of Urology and Urologic Oncology, Alfried Krupp Krankenhaus, Essen, Germany.
authors.forename: Phillip
authors.initials: P
authors.lastname: Klumpen
authors.affiliation: Department of Urology and Urologic Oncology, Alfried Krupp Krankenhaus, Essen, Germany.
authors.forename: Assen
authors.initials: A
authors.lastname: Alexandrov
authors.affiliation: Department of Urology and Pediatric Urology, University Hospital of Frankfurt, Frankfurt, Germany.
authors.forename: Rene
authors.initials: R
authors.lastname: Mager
authors.affiliation: OLV Vattikuti Robotic Surgery Institute, OLV Hospital Aalst, Aalst, Belgium.|Department of Urology, OLV Hospital Aalst, Aalst, Belgium.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Mottrie
authors.affiliation: Department of Urology and Pediatric Urology, University Hospital of Frankfurt, Frankfurt, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Haferkamp
mesh_terms: D003362:Cost-Benefit Analysis; D003663:Decision Trees; D006801:Humans; D010535:Laparoscopy / Q000191:economics*; D008962:Models, Theoretical; D009392:Nephrectomy / Q000191:economics* / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control*; D065287:Robotic Surgical Procedures / Q000191:economics*
keywords: Cost-effectiveness; Minimal invasive surgery; Partial nephrectomy; Robotic surgery