Abstract
With the current patterns of adoption and use of robotic surgery and improvement in the overall survival of patients with prostate cancer, it is important to evaluate the immediate and long-term cost implications of treatments for patients with prostate cancer. To compare health care costs and use 1 year after open radical prostatectomy (ORP) vs robotic-assisted radical prostatectomy (RARP). This retrospective cohort study used a US commercial claims database from January 1, 2013, to December 31, 2018. A total of 11 457 men aged 18 to 64 years who underwent inpatient radical prostatectomy for prostate cancer and were continuously enrolled with medical and prescription drug coverage from 180 days before to 365 days after inpatient prostatectomy were identified. An inverse probability of treatment weighting analysis was performed to examine the differences in costs and use of health care services by surgical modality. Data analysis was conducted from September 2019 to July 2020. Type of surgical procedure: ORP vs RARP. Three outcomes within 1 year after the inpatient prostatectomy were investigated: (1) total health care costs, including reimbursement paid by insurers and out of pocket by patients; (2) health care use, including inpatient readmission, emergency department, hospital outpatient, and office visits; and (3) estimated days missed from work due to health care use. Of the 11 457 patients who underwent inpatient prostatectomy, 1604 (14.0%) had ORP and 9853 (86.0%) had RARP and most patients (8467 [73.9%]) were aged 55 to 64 years. Compared with patients who underwent ORP, those who received RARP had a higher cost at the index hospitalization (mean difference, $2367; 95% CI, $1821-$2914; P < .001), but similar total cumulative costs were observed within 180 days (mean difference, $397; 95% CI, -$582 to $1375; P = .43) and 1 year after discharge (-$383; 95% CI, -$1802 to $1037; P = .60). One-year postdischarge health care use was significantly lower in the RARP compared with ORP group for mean numbers of emergency department visits (-0.09 visits; 95% CI, -0.11 to -0.07 visits; P < .001) and hospital outpatient visits (-1.5 visits; -1.63 to -1.36 visits; P < .001). The reduction in use of health care services among patients who underwent RARP translated into additional savings of $2929 (95% CI, $1600-$4257; P < .001) and approximately 1.69 fewer days (95% CI, 1.49-1.89 days; P < .001) missed from work for health care visits. Total cumulative cost in this study was similar between ORP and RARP 1 year post discharge; this finding suggests that lower postdischarge health care use after RARP may offset the higher costs during the index hospitalization.
Highlights
Compared with patients who underwent open radical prostatectomy (ORP), those who received robotic-assisted radical prostatectomy (RARP) had a higher cost at the index hospitalization, but similar total cumulative costs were observed within 180 days and 1 year after discharge (−$383; 95% CI, −$1802 to $1037; P = .60)
One-year postdischarge health care use was significantly lower in the RARP compared with ORP group for mean numbers of emergency department visits (−0.09 visits; 95% CI, −0.11 to −0.07 visits; P < .001) and hospital outpatient visits (−1.5 visits; −1.63 to −1.36 visits; P < .001)
Total cumulative cost in this study was similar between ORP and RARP 1 year post discharge; this finding suggests that lower postdischarge health care use after RARP may offset the higher costs during the index hospitalization
Summary
Prostate cancer is the most commonly diagnosed cancer in men older than 50 years in the US,[1,2] accounting for about one-fifth of all new cancers in men in 2019.3 Since the development of prostatespecific antigen testing and improvement in treatment strategies, the incidence and early detection of organ-confined prostate cancer have increased, with an increase in the 5-year survival rate.[4,5] The overall decrease in mortality, with an increase in the prevalence of prostate cancer,[6] underscores the importance of evaluating the immediate and long-term cost implications of treatments for patients with prostate cancer and their effects in the health care system. the treatment approach for prostate cancer varies by geographic location, cancer stage, and available technology,[7] over the years there has been a shift of surgical management of prostate cancers to more minimally invasive methods, such as laparoscopic surgeries and, more recently, robotic-assisted surgeries.[8]. Studies comparing the perioperative benefit of robotic-assisted prostatectomy vs open surgery have reported reduced blood loss, shorter length of hospital stay, fewer intraoperative and postoperative complications, and better functional outcomes.[1,12,13,14] opting for robotic surgery based on these benefits comes at a cost. Comparing the costs of laparoscopic and robotic-assisted prostatectomies with open prostatectomies, Lotan et al[15] reported that open prostatectomies were the least expensive and most cost-effective approach to prostatectomy. Another study reported that the robotic approach may not be more costly in all care settings, and cost may differ by hospital type and setting and might be dependent on the length of stay and local hospitalization cost.[16]
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