Objective:Our present understanding of the effect of robotic surgery and surgical volume on the cost of radical prostatectomy (RP) is limited.
Given the increasing pressures placed on healthcare resource utilization, such determinations of healthcare value are becoming increasingly important. Therefore we sought to define the effect of robotic technology and surgical volume on the cost of RP.
Methods:The state of Maryland mandates that all acute-care hospitals report encounter-level and hospital discharge data to the Health Service Cost Review Commission (HSCRC). The HSCRC was queried for men undergoing RP between 2008-2011 (the period during which robotic assisted laparoscopic radical prostatectomy [RALRP] was coded separately). High volume hospitals were defined as >60 cases/year, and high volume surgeons defined as >40 cases/year. Multivariate regression analysis was performed to evaluate whether robotic technique and surgical volume impacted the cost of RP.
Results:1499 patients underwent RALRP and 2565 underwent radical retropubic prostatectomy (RRP) during the study period. The total cost for RALRP was higher than for RRP ($14,000 vs. 10,100; p< 0.001) based primarily on operating room charges and supply charges. Multivariate regression demonstrated that RALRP was associated with a significantly higher cost (β coeff 4.1; p< 0.001), even within high volume hospitals (β coeff 3.3; p< 0.001). However, high volume surgeons and high volume hospitals were associated with a significantly lower cost for RP overall. High surgeon volume was associated with lower cost for RALRP and RRP, while high institutional volume was associated with lower cost for RALRP only.
Conclusions: High surgical volume was associated with lower cost of RP. However, even at high surgical volume, the cost of RALRP still exceeded that of RRP. As robotic surgery has come to dominate the health care marketplace, strategies to increase the role of high volume providers may be needed to improve the cost effectiveness of prostate cancer surgical therapy.
Written by:
Hyams ES, Mullins JK, Pierorazio P, Partin AW, Allaf M, Matlaga B. Are you the author?
Johns Hopkins School of Medicine, Brady Urological Institute, 600 N. Wolfe St, Park 2, Baltimore, Maryland, United States, 21230.
Reference: J Endourol. 2012 Sep 11. Epub ahead of print.
doi: 10.1089/end.2012.0147
PubMed Abstract
PMID: 22967039
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