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Surgeon’s Corner
Cost-Effectiveness of Conventional vs Robotic-Assisted Laparoscopy in Gynecologic Oncologic Indications
  1. Patricia Marino, PhD*,†,
  2. Gilles Houvenaeghel, PhD*,
  3. Fabrice Narducci, MD‡,
  4. Agnès Boyer-Chammard, MD*,
  5. Gwenaël Ferron, PhD§,
  6. Catherine Uzan, PhD∥,
  7. Anne-Sophie Bats, PhD,
  8. Philippe Mathevet, PhD#,
  9. Philippe Dessogne, MD**,
  10. Frédéric Guyon, MD†,‡,
  11. Philippe Rouanet, PhD†,‡,
  12. Isabelle Jaffre, MD§§,
  13. Xavier Carcopino, PhD∥∥,
  14. Thomas Perez, MD¶¶ and
  15. Eric Lambaudie, PhD*
  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, Rouen, France;
  9. ††Bergonié Institute, Bordeaux, France;
  10. ‡‡Val D’aurelle Center, Montpellier, France;
  11. §§Rene Gauducheau Center, Nantes, France;
  12. ∥∥Hôpital Nord, Marseille, France; and
  13. ¶¶La Casamance, private hospital, Aubagne, France.
  1. Address correspondence and reprint requests to Patricia Marino, PhD, Institut Paoli Calmettes, Inserm UMR 912, 232 Boulevard de Sainte Marguerite, 13009 Marseille, France. E-mail: patricia.marino{at}inserm.fr.

Abstract

Objective 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 gynecologic 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 multicenter study. The direct costs, operating theater costs, and hospital costs were calculated for both surgical strategies using the microcosting 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 €1456 per intervention. The robot-specific costs amounted to €2213 per intervention, and the cost of the robot-specific surgical supplies was €957 per intervention. The cost of the surgical supplies specifically required by conventional laparoscopy amounted to €1432, which is significantly higher than that of the robotic supplies (P < 0.001). Hospital costs were lower in the case of the robotic strategy (€2380 vs €2841, P < 0.001) because these patients spent less time in intensive care (0.38 vs 0.85 days). Operating theater costs were higher in the case of the robotic strategy (€1490 vs €1311, P = 0.0004) because the procedure takes longer to perform (4.98 hours vs 4.38 hours).

Conclusions 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 theater costs, resulting in financial benefits to society.

  • Economic evaluation
  • Robotic surgery
  • Laparoscopy
  • Gynecology

http://dx.doi.org/10.1097/IGC.0000000000000458

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    Footnotes

    • Funding: This research was supported by a “Programme de Soutien aux Techniques Innovantes et Couteuses” grant from the French Ministry of Health (STIC 2007).

    • Authors’ Disclosure: P. Marino has no conflicts of interest or financial ties to declare. G. Houvenaeghel and E. Lambaudie are proctors for Intuitive Surgical. F. Narducci, A. Boyer-Chammerd, G. Ferron, C. Uzan, A.S. Bats, P. Mathevet, P. Dessogne, F. Guyon, P. Pouanet, I. Jaffre, X. Carcopino, and T. Perez have no conflicts of interest to declare.