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Cost-Effectiveness Analysis of Robotically Assisted Laparoscopy for Newly Diagnosed Uterine Cancers

Leitao, Mario M. Jr MD; Bartashnik, Aleksandra MA; Wagner, Isaac MS; Lee, Stephen J. MD; Caroline, Ari MS, MBA; Hoskins, William J. MD; Thaler, Howard T. PhD; Abu-Rustum, Nadeem R. MD; Sonoda, Yukio MD; Brown, Carol L. MD; Jewell, Elizabeth L. MD; Barakat, Richard R. MD; Gardner, Ginger J. MD

doi: 10.1097/AOG.0000000000000223
Contents: Original Research

OBJECTIVE: To assess the direct costs of three surgical approaches in uterine cancer and the cost-effectiveness of incorporating robot-assisted surgery.

METHODS: A cost system that allocates the actual cost of resources used to treat each patient, as opposed to borrowing cost data from a billing system, was used to determine direct costs for patients who underwent surgery for uterine cancer from 2009 to 2010. These costs included all aspects of surgical care up to 6 months after discharge. Total amortized direct costs included the capital cost of three dual-console robotic platforms with 5 years of service contracts. Nonamortized costs were also calculated (excluded capital costs). Modeling was performed to estimate the mean cost of surgical care for patients presenting with endometrial cancer from 2007 to 2010.

RESULTS: Of 436 cases (132 laparoscopic, 262 robotic, 42 laparotomy), total mean amortized direct costs per case were $20,489 (laparoscopy), $23,646 (robot), and $24,642 (laparotomy) (P<.05 [robot compared with laparoscopy]; P=.6 [robot compared with laparotomy]). Total nonamortized costs per case were $20,289, $20,467, and $24,433, respectively (P=.9 [robot compared with laparoscopy]; P=.03 [robot compared with laparotomy]). The planned surgical approach in 2007 was laparoscopy, 68%; robot, 8%; and laparotomy, 24% compared with 26%, 64%, and 9%, respectively, in 2010 (P<.001). The modeled mean amortized direct costs per case were $21,738 in 2007 and $22,678 in 2010 (+$940). Nonamortized costs were $21,298 in 2007 and $20,573 in 2010 (−$725).

CONCLUSION: Laparoscopy is least expensive when including capital acquisition costs. Laparoscopy and robotic surgery are comparable if upfront costs are excluded. There is cost neutralization with the robot when it helps decrease laparotomy rates.

The costs of robotically assisted laparoscopic surgery can be attenuated once learning curves are overcome and are less than the costs of laparotomy.

Gynecology Service, Department of Surgery, Strategic Planning and Innovation, Quantitative Analysis and Strategic Initiatives, and the Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York.

Corresponding author: Mario M. Leitao Jr, MD, Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065; e-mail: leitaom@mskcc.org.

Funded in part by the cancer center core grant P30 CA008748. The core grant provides funding to institutional cores such as Biostatistics, which was used in this article.

Financial Disclosure Dr. Leitao is a surgical proctor and consultant for Intuitive Surgical. Dr. Jewell is a speaker for Covidien and Intuitive Surgical. The other authors did not disclose any potential conflicts of interest.

© 2014 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.