The economics of robotic cystectomy: cost comparison of open versus robotic cystectomy

OBJECTIVE To assess and compare the economic burden of open radical cystectomy (OC) vs robotic-assisted laparoscopic radical cystectomy (RC) with pelvic lymph node dissection and urinary diversion. PATIENTS AND METHODS A series of 103 and 83 consecutive patients undergoing OC and RC, respectively, were prospectively studied at a tertiary care institution from April 2002 to February 2009. Data were collected on patient demographics, perioperative parameters and length of stay (LOS) in hospital. Cohorts were subdivided into ileal conduit (IC), continent cutaneous diversion (CCD) and orthotopic neobladder (ON) subgroups. A linear cost model was created to simulate treatment with OC vs RC. Procedural costs were derived from the Medicare Resource Based Relative Value Scale. Materials costs were obtained from the respective suppliers. The indirect costs of complications were considered. Sensitivity analyses were performed. RESULTS Despite a higher cost of materials, RC was less expensive than OC for IC and CCD, although the cost advantage deteriorated for ON. The per-case costs of RC with IC, CCD and ON were $20 659, $22 102 and $22 685, respectively, compared to $25 505, $22 697 and $20 719 for their OC counterparts. The largest cost driver in the study was LOS in hospital. RC showed a shorter LOS compared to OC, although this effect was insufficient to offset the higher cost of robotic surgery. Complications materially affected cost performance. CONCLUSIONS Despite a higher cost of materials, RC can be more cost efficient than OC as a treatment for bladder cancer at a high-volume, tertiary care referral centre, particularly with IC. Complications significantly impact cost performance.