Abstract
Enhanced recovery protocols and robotic approaches to radical cystectomy are known to reduce perioperative complications; however, the most cost-effective strategy is unknown. We aim to assess the cost effectiveness of radical cystectomy with different surgical techniques and perioperative treatment protocols. We performed a meta-analysis of studies comparing open radical cystectomy (ORC), robotic assisted radical cystectomy (RARC) using extracorporeal (ECUD) or intracorporeal urinary diversion (ICUD) and enhanced recovery after surgery (ERAS) protocols. Operative time, transfusion, complication, Ileus, length of stay and re-admission rates were extracted. US costs for surgery, treatment, hospitalization and complications were obtained from the literature. Israeli costs were obtained from hospital administrative data. Two cost effectiveness models (US and Israel) were developed. The two most cost-effective strategies in both models were ORC with ERAS and RARC with ICUD and ERAS. RARC with ERAS produced the two most effective strategies with ICUD being dominant over ECUD. All strategies implementing the ERAS protocol were more effective than their parallel non-ERAS strategies. RARC with ICUD and ERAS is cost effective compared to ORC. ERAS protocol improves treatment effectiveness and lowers overall costs. ICUD was shown to be more effective and less costly in comparison to ECUD.
Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
