title: A comparative cost analysis of robotic-assisted surgery versus laparoscopic surgery and open surgery: the necessity of investing knowledgeably.
abstract: Robotic surgery has been proposed as a minimally invasive surgical technique with advantages for both surgeons and patients, but is associated with high costs (installation, use and maintenance). The Health Technology Assessment Unit of the Bambino Gesù Children's Hospital sought to investigate the economic sustainability of robotic surgery, having foreseen its impact on the hospital budget METHODS: Break-even and cost-minimization analyses were performed. A deterministic approach for sensitivity analysis was applied by varying the values of parameters between pre-defined ranges in different scenarios to see how the outcomes might differ.
  
  
  
  The break-even analysis indicated that at least 349 annual interventions would need to be carried out to reach the break-even point. The cost-minimization analysis showed that robotic surgery was the most expensive procedure among the considered alternatives (in terms of the contribution margin).
  
  
  
  Robotic surgery is a good clinical alternative to laparoscopic and open surgery (for many pediatric operations). However, the costs of robotic procedures are higher than the equivalent laparoscopic and open surgical interventions. Therefore, in the short run, these findings do not seem to support the decision to introduce a robotic system in our hospital.
authors.affiliation: Health Technology Assessment and Safety Research Unit, Bambino Gesù Children's Hospital, Viale Baldelli, 41, 00146, Rome, Italy. giorgia.tedesco@opbg.net.
authors.forename: Giorgia
authors.identifier: 0000-0002-6137-575X
authors.initials: G
authors.lastname: Tedesco
authors.affiliation: Health Technology Assessment and Safety Research Unit, Bambino Gesù Children's Hospital, Viale Baldelli, 41, 00146, Rome, Italy.
authors.forename: Francesco C
authors.initials: FC
authors.lastname: Faggiano
authors.affiliation: Health Technology Assessment and Safety Research Unit, Bambino Gesù Children's Hospital, Viale Baldelli, 41, 00146, Rome, Italy.
authors.forename: Erica
authors.initials: E
authors.lastname: Leo
authors.affiliation: Technology, Facility and Risk Management Direction, Bambino Gesù Children's Hospital, P.zza S. Onofrio, 4, 00165, Rome, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Derrico
authors.affiliation: Health Technology Assessment and Safety Research Unit, Bambino Gesù Children's Hospital, Viale Baldelli, 41, 00146, Rome, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Ritrovato
mesh_terms: D002648:Child; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D006801:Humans; D007558:Italy; D010535:Laparoscopy / Q000191:economics* / Q000193:education; D010372:Pediatrics; D065287:Robotic Surgical Procedures / Q000191:economics* / Q000193:education
keywords: Break-even point; Cost minimization; Pediatric robotic surgery; Robotic surgical system