Robotics adds nearly 40% to cost of prostate surgery

Use of robotics added almost 40% to the average cost of a radical prostatectomy compared with radical retropubic prostatectomy (RRP), analysis of a statewide database showed.

The cost of a robot-assisted laparoscopic radical prostatectomy (RALRP) averaged $14,000 versus $10,100 for RRP. Higher charges for operating room time and supplies for the robotic procedure accounted for most of the difference.

A similar differential existed among high-volume institutions and high-volume surgeons. However, higher-volume centers and surgeons were associated with a lower cost for RRP (p

"No definitive conclusions can be drawn from this study, but the findings are provocative," said first author Elias S. Hyams, MD, of Johns Hopkins University in Baltimore. "The study confirms a cost differential that has been reported by others.

"Even though we, as urologic surgeons, tend to focus on caring for the individual patient, I think we do need to step back and take more of a macroscopic look at the costs and see whether we can identify ways to make robotic surgery more cost-effective," added Dr. Hyams, who worked on the study with Brian R. Matlaga, MD, and colleagues.

Robot-assisted surgery has faced increasing scrutiny as data have emerged to suggest that the technology is associated with higher costs compared with conventional surgery. To examine the issue, Dr. Hyams and colleagues reviewed records from the Maryland Health Service Cost Review Commission, which requires the state’s acute care hospitals to report encounter-level and discharge data.

The study encompassed 2008 to 2011, during which time 1,499 men underwent RALRP and 2,565 underwent RRP. The $3,900 cost differential was statistically significant (pp

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