Perioperative Costs Vary Significantly According to Surgical Technique

A significant variation in perioperative costs according to surgical technique for both patients (out-of-pocket costs) and payers (total payments) was observed in this study published in JAMA Network Open. 

Furthermore, across all oncologic procedures studied, the robotic approach was most associated with lower out-of-pocket costs. 

“These results highlight the complexity of economic factors that are associated with the rapid adoption and possible subsidization of the robotic approach for common surgically amenable conditions and lay a foundation for future work on this issue,” the authors wrote.

In this retrospective cohort of 15,893 adults, patients underwent either an open or robotic radical prostatectomy, hysterectomy, partial colectomy, radical nephrectomy, or partial nephrectomy for a solid malignant neoplasm. Of that cohort, 8,260 underwent robotic procedures and 7,633 underwent open procedures. Researchers observed that those undergoing robotic hysterectomy were older than those undergoing open, and patients undergoing radical nephrectomy had more comorbidities than those undergoing robotic radical nephrectomy.

After adjusting for baseline characteristics, the robotic approach was found to be associated with lower out-of-pocket costs for all procedures: –$137.75 (95% CI, −$240.24 to −$38.63) for radical prostatectomy (P = .006); −$640.63 (95% CI, −$933.62 to −$368.79) for hysterectomy (P < .001); –$1140.54 (95% CI, −$1397.79 to −$896.54) for partial colectomy (P < .001); –$728.32 (95% CI, −$1126.90 to −$366.08) for radical nephrectomy (P < .001); and –$302.74 (95% CI, −$523.14 to −$97.10) for partial nephrectomy (P = .003). 

Similarly, the robotic approach was also associated with lower adjusted total payments: –$3872.62 (95% CI, −$5385.49 to −$2399.04) for radical prostatectomy (P < .001); 

–$29 640.69 (95% CI, −$36 243.82 to −$23 465.94) for hysterectomy (P < .001); –$38 151.74 (95% CI, −$46 386.16 to −$30 346.22) for partial colectomy; (P < .001); –$33 394.15 (95% CI, −$42 603.03 to −$24 955.20) for radical nephrectomy (P < .001); and –$9162.52 (95% CI, −$12 728.33 to −$5781.99) for partial nephrectomy (P < .001). 

Notably, the researchers indicated that these analyses did not account for the costs of procuring and maintain a robotic system. Additionally, prior economic analyses have shown that robotic surgery could be more expensive perioperatively than open surgery when considering the costs of robotic maintenance and disposable instruments. 

“Given that the cost of the acquisition and maintenance of surgical robotics are not accounted for in this analysis, it is plausible that robotic surgery exhibits small gains compared with the conventional open approaches through shorter [length of stay], use of pain medication, and use of laboratory tests, among other factors,” the authors wrote. 

The data presented indicates that the additional costs of robot acquisition and maintenance are seemingly absorbed by the hospitals. Although the exact reason for this is unclear, there are a few plausible explanations, including the net profit of robotic surgery being higher than the cost and patient demand for robotic surgery increasing in the last decade. 

According to the study, as of 2017, US national health expenditures stood at $3.5 trillion and despite reforms intended to decrease these expenditures, overall US health care spending currently remains on an unsustainable course.

Reference:

Nabi J, Friedlander DF, Chen X, et al. Assessment of Out-of-Pocket Costs for Robotic Cancer Surgery in US Adults. JAMA Network Open. doi:10.1001/jamanetworkopen.2019.19185.