Robotic partial nephrectomy not cost-effective, researchers say

The average cost of a laparoscopic partial nephrectomy is nearly $1,500 higher with robot-assisted versus hand-assisted procedures, a retrospective comparative chart review presented yesterday showed.

Robot-assisted laparoscopic partial nephrectomy had a mean cost of $9,409 compared with an average of $7,917 for hand-assisted procedures. The difference resulted primarily from increased time in the operating room and expenditures for surgical supplies, say researchers from Brown University, Providence, RI.

The findings have potentially major implications for urologic practice.

"Ultimately, we’re all going to be accountable for providing the best quality of care and the most cost-effective care," said senior author Gyan Pareek, MD. "If we can save $1,500 per patient, and a patient comes to me with a kidney lesion that is amenable to a partial nephrectomy, then I will have to ask, 'What is the most cost-effective and best way to treat this patient?'

"If the outcomes are similar for the two procedures, then if you can save $1,500, that’s being pretty accountable."

The analysis involved 69 patients who underwent minimally invasive partial nephrectomy during 2006-2010. In 47 cases, patients underwent hand-assisted laparoscopic partial nephrectomy, and the remaining patients had robot-assisted procedures.

The time to complete a robot-assisted laparoscopic partial nephrectomy averaged 276 minutes compared with 206 minutes with the hand-assisted procedures. The additional time translated into an additional $1,100 per case for OR time ($3,745 vs. $2,645). Anesthesia time also was longer with robotic procedures, adding an additional $125 to the average cost compared with hand-assisted procedures.

The cost of common surgical supplies was identical for the two types of surgery, but the cost of surgical supplies unique to robot-assisted procedures averaged $1,450 compared with $955 for hand-assisted laparoscopic partial nephrectomy.

Hospital length of stay averaged 3.5 days with robot-assisted partial nephrectomy versus 4.0 days with hand-assisted minimally invasive partial nephrectomy, which translated into a difference of about $230 for medication and room and board.

The cost savings have to be balanced against any differences in clinical outcomes, acknowledged first author Sammy Elsamra, MD. Preliminary analysis suggests the oncologic outcomes are similar with the two minimally invasive strategies.