The American College of Obstetricians and Gynecologists recommends vaginal hysterectomy as a primary method for performing hysterectomy. This route is less costly than either abdominal or traditional laparoscopic approaches. Over the past 10 to 15 years, the robotic approach to hysterectomy has become increasingly popular, and many health care practitioners have incorporated it into their practice. Several studies have shown that the robotically assisted hysterectomy may be more expensive than traditional laparoscopy and laparotomy. Although it seems likely that robotic hysterectomy should also be more expensive than vaginal hysterectomy, only 2 studies have directly compared inpatient costs between these 2 methods.
This retrospective study was designed to compare the costs of robotically assisted hysterectomy with vaginal and abdominal hysterectomy. The investigators identified all cases of robotically assisted hysterectomy, with or without bilateral salpingo-oophorectomy, performed at the Mayo Clinic (Rochester, Minn) from January 1, 2007, through December 31, 2009. Cases of robotic hysterectomy were propensity score matched one-to-one to cases of vaginal and abdominal hysterectomy selected randomly for the years 2004 through 2006 (before acquisition of the robotic system).
The Olmsted County Healthcare Expenditure and Utilization Database was used to abstract all billed costs through the sixth postoperative week. Costs were compared between cohorts with a generalized linear modeling framework. The recycled predictions method was used to estimate predicted costs for the procedures as well as costs of operative complications and the difference in predicted costs between groups.
Robotic cases were compared with 234 cases of abdominal hysterectomies and 212 cases of vaginal hysterectomies. The predicted mean cost of robotic hysterectomy per patient was $2253 higher than that of vaginal hysterectomy ($13,619 vs $11,366; P < 0.001). The predicted mean costs of robotic and abdominal hysterectomy were similar ($14,679 vs $15,588, respectively; P < 0.35). Costs of complications for the 3 groups were not significantly different.
These findings show that robotically assisted hysterectomy is more costly than vaginal hysterectomy and support the American College of Obstetricians and Gynecologists’ recommendation that the preferred route of hysterectomy be vaginal.
Urogynecology and Continence Center, Methodist Physicians Clinic, Omaha, NE; and Divisions of Health Care Policy and Research and Gynecologic Surgery, Mayo Clinic, Rochester, MN