Cost-effectiveness of conventional vs robotic

Cost-effectiveness of conventional vs robotic-assisted laparoscopy in gyn-oncologic
indications.
P Marino, 1,2, G Houvenaeghel 1, F Narducci 3, A Boyer-Chammard MD 1, G Ferron 4, C
Uzan 5, AS Bats 6, P Mathevet 7, P Dessogne 8, F Guyon 9, P Rouanet 10, I Jaffre 11, X
Carcopino 12, T Perez 13, E Lambaudie 1.
1 Paoli Calmettes Institute, Marseille, France
2 Inserm UMR 912 SESSTIM, Marseille, France
3 Oscar Lambret Center, Lille, France
4 Claudius Regaud Institute, Toulouse, France
5 Gustave Roussy Institute, Villejuif, France
6 Hôpital Européen Georges Pompidou, Paris, France
7 Hôpital Edouard Herriot, Lyon, France
8 Henri Becquerel Center, Amiens, France
9 Bergonié Institute, Bordeaux, France
10 Val D’aurelle Center, Montpellier, France
11 René Gauducheau Center, Nantes, France
12 Hôpital Nord, Marseille, France
13 La Casamance, private hospital, Aubagne, France
ABSTACT
Background: Robotic surgical techniques are known to be expensive, but they can decrease
the cost of hospitalization and improve patients’ outcomes. The aim of this study was to
compare the costs and clinical outcomes of conventional laparoscopy vs robotic-assisted
laparoscopy in the gyn-oncologic indications.
Methods: Between 2007 and 2010, 312 patients referred for gynecologic oncologic
indications (endometrial and cervical cancer), including 226 who underwent conventional
laparoscopy and 80 who underwent robot-assisted laparoscopy,
were included in this
prospective multi-centre study. The direct costs, operating theatre costs and hospital costs
were calculated for both surgical strategies using the micro-costing method.
Results: Based on an average number of 165 surgical cases performed per year with the
robot, the total extra cost of using the robot was 1,456€ per intervention. The robot-specific
costs amounted to 2,213€ per intervention, and the cost of the robot-specific surgical supplies,
to 957€ per intervention. The cost of the surgical supplies specifically required by
conventional laparoscopy amounted to 1,432€, which is significantly higher than that of the
robotic supplies (p<0.001). Hospital costs were lower in the case of the robotic strategy
(2,380€ vs 2,841€, p<0.001) because these patients spent less time in intensive care (0.38 vs
0.85 days). Operating theatre costs were higher in the case of the robotic strategy (1,490€ vs
1,311€, p=0.0004) because the procedure takes longer to perform (4.98h vs 4.38h).
Conclusion: The main driver of additional costs is the fixed cost of the robot, which is not
compensated by the lower hospital room costs. The robot would be more cost-effective if
robotic interventions were performed on a larger number of patients per year or if the
purchase price of the robot was reduced. A shorter learning curve would also no doubt
decrease the operating theatre costs, resulting in financial benefits to society.