title: Cost analysis of minimally invasive hysterectomy vs open approach performed by a single surgeon in an Italian center.
abstract: Despite the rapid uptake of robotic surgery, the effectiveness of robotically assisted hysterectomy (RAH) remains uncertain, due to the costs widely variable. Observed the different related costs of robotic procedures, in different countries, we performed a detailed economic analysis of the cost of RAH compared with total laparoscopic (TLH) and open hysterectomy (OH). The three surgical routes were matched according to age, BMI, and comorbidities. Hysterectomy costs were collected prospectively from September 2014 to September 2015. Direct costs were determined by examining the overall medical pathway for each type of intervention. Surgical procedure cost for RAH was €3598 compared with €912 for TLH and €1094 for OH. The cost of the robot-specific supplies was €2705 per intervention. When considering overall medical surgical care, the patient treatment average cost of a RAH was €4695 with a hospital stay (HS) of 2 days (range 2-4) compared with €2053 for TLH and €2846 for OH. The main driver of additional costs is disposable instruments of the robot, which is not compensated by the hospital room costs and by an experienced team staff. Implementation of strategies to reduce the cost of robotic instrumentation is due. No significant cost difference among the three procedures was observed; however, despite the optimal operative time, the experienced, surgeon and the lower HS, RAH resulted 2, 3 times and 1, 6 times more expensive in our institution than TLH and OH, respectively.
authors.affiliation: Department of Obstetrics and Gynecology, ASTT LECCO, Alessandro Manzoni Hospital, Dell'Eremo Street 11, Lecco, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Pellegrino
authors.affiliation: Department of Obstetrics and Gynecology, ASTT LECCO, Alessandro Manzoni Hospital, Dell'Eremo Street 11, Lecco, Italy. damiani14@alice.it.|Department of Obstetrics and Gynecology, University of Bologna-Sant'orsola, Bologna, Italy. damiani14@alice.it.
authors.forename: Gianluca Raffaello
authors.initials: GR
authors.lastname: Damiani
authors.affiliation: Department of Obstetrics and Gynecology, ASTT LECCO, Alessandro Manzoni Hospital, Dell'Eremo Street 11, Lecco, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Fachechi
authors.affiliation: Department of Obstetrics and Gynecology, ASTT LECCO, Alessandro Manzoni Hospital, Dell'Eremo Street 11, Lecco, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Corso
authors.affiliation: Department of Obstetrics and Gynecology, ASTT LECCO, Alessandro Manzoni Hospital, Dell'Eremo Street 11, Lecco, Italy.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Pirovano
authors.affiliation: Department of Obstetrics and Gynecology, ASTT LECCO, Alessandro Manzoni Hospital, Dell'Eremo Street 11, Lecco, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: Trio
authors.affiliation: Department of Obstetrics and Gynecology, ASTT LECCO, Alessandro Manzoni Hospital, Dell'Eremo Street 11, Lecco, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Villa
authors.affiliation: Department of Obstetrics and Gynecology, ASTT LECCO, Alessandro Manzoni Hospital, Dell'Eremo Street 11, Lecco, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Turoli
authors.affiliation: Department of Obstetrics and Gynecology, University of Bologna-Sant'orsola, Bologna, Italy.
authors.forename: Aly
authors.initials: A
authors.lastname: Youssef
mesh_terms: D005260:Female; D017048:Health Care Costs; D006801:Humans; D007044:Hysterectomy / Q000191:economics / Q000379:methods*; D007558:Italy; D010535:Laparoscopy / Q000191:economics / Q000379:methods; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000191:economics / Q000379:methods*; D011446:Prospective Studies; D065287:Robotic Surgical Procedures / Q000191:economics / Q000379:methods*
keywords: Cost analysis; Lapaprotomy; Laparoscopy; Robotic surgery