942 COST COMPARION OF ROBOTIC-ASSISTED AND LAPAROSCOPIC PYELOPLASTY

Abstract

You have accessJournal of UrologyTechnology & Instruments: Robotics/Laparoscopy1 Apr 2011942 COST COMPARION OF ROBOTIC-ASSISTED AND LAPAROSCOPIC PYELOPLASTY Joshua Sleeper, Nicholas Cost, and Yair Lotan Joshua SleeperJoshua Sleeper Dallas, TX More articles by this author , Nicholas CostNicholas Cost Dallas, TX More articles by this author , and Yair LotanYair Lotan Dallas, TX More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.860AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Laparoscopic repair of ureteropelvic junction obstruction is now the standard of care at many institutions. The objective of this study is to compare costs associated with robotic-assisted (RP) versus laparoscopic pyeloplasty (LP). METHODS A literature search was performed to identify non-overlapping studies with outcomes for RP and LP. Weighted means were calculated for operative time and length of stay. Cost data was obtained from our institution. The cost for the robot and maintenance contract was amortized over 7 years. Professional fees for anesthesia and the surgeon were included. A decision analysis model was developed to compare costs of each procedure based on hospital related cost centers. One and two way sensitivity analyses were performed to evaluate the effect of changing variables on the cost-effectiveness of RP. RESULTS 8 studies were identified with 181 and 145 patients undergoing RP or LP respectively. Operative times were 211 minutes for RP and 224 minutes for LP. Hospital stays were shorter for RP at 1.54 days compared to 1.98 days for LP. Mean direct costs were higher for RP at $10,634.51 versus $9,065.44 for LP. The largest difference was in fixed surgical supply costs per case at $1357 for RP and $406 for LP. Assuming 300 cases per year, the purchase and maintenance costs for the robot amount to $1,214 in additional costs per patient. One way sensitivity analysis showed that a RP would be cost effective if performed in less than 96 minutes. However, even if RP was performed on an outpatient basis or more than 1000 cases/year, LP would still be cost superior. Two way analyses showed areas where RP could be more cost-effective than LP. A RP performed in 2 hours would be more cost-effective if the surgical supply cost was reduced to $1,000, if hospital stay was 19 hours, or if a LP took twice as long. CONCLUSIONS RP is associated with higher cost compared to LP, predominately due to the cost of the robot and higher surgical costs. Decreasing operative time and equipment costs may result in RP being more cost-effective than LP. However, shorter hospital stay alone is insufficient to allow RP to be cost-effective. One would need to demonstrate tangible advantages to the robotic approach to justify the added costs. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e378 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joshua Sleeper Dallas, TX More articles by this author Nicholas Cost Dallas, TX More articles by this author Yair Lotan Dallas, TX More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...