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Published in: Surgical Endoscopy 11/2016

01-11-2016

A comparative cost analysis of robotic-assisted surgery versus laparoscopic surgery and open surgery: the necessity of investing knowledgeably

Authors: Giorgia Tedesco, Francesco C. Faggiano, Erica Leo, Pietro Derrico, Matteo Ritrovato

Published in: Surgical Endoscopy | Issue 11/2016

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Abstract

Background

Robotic surgery has been proposed as a minimally invasive surgical technique with advantages for both surgeons and patients, but is associated with high costs (installation, use and maintenance). The Health Technology Assessment Unit of the Bambino Gesù Children’s Hospital sought to investigate the economic sustainability of robotic surgery, having foreseen its impact on the hospital budget

Methods

Break-even and cost-minimization analyses were performed. A deterministic approach for sensitivity analysis was applied by varying the values of parameters between pre-defined ranges in different scenarios to see how the outcomes might differ.

Results

The break-even analysis indicated that at least 349 annual interventions would need to be carried out to reach the break-even point. The cost-minimization analysis showed that robotic surgery was the most expensive procedure among the considered alternatives (in terms of the contribution margin).

Conclusions

Robotic surgery is a good clinical alternative to laparoscopic and open surgery (for many pediatric operations). However, the costs of robotic procedures are higher than the equivalent laparoscopic and open surgical interventions. Therefore, in the short run, these findings do not seem to support the decision to introduce a robotic system in our hospital.
Literature
1.
go back to reference Mennini SF, Cicchetti A, Fattore G, Russo P (2010) Metodi per la valutazione economica dei programmi sanitari. In: Drummond MF, Sculpher MJ, Torrance GW, O’Brien BJ, Stoddart GL (eds) Methods for the economic evaluation of health care programmes, 3rd edn. Oxford University Press, New York Mennini SF, Cicchetti A, Fattore G, Russo P (2010) Metodi per la valutazione economica dei programmi sanitari. In: Drummond MF, Sculpher MJ, Torrance GW, O’Brien BJ, Stoddart GL (eds) Methods for the economic evaluation of health care programmes, 3rd edn. Oxford University Press, New York
3.
go back to reference Camps JI (2011) The use of robotics in pediatric surgery: my initial experience. Pediatr Surg Int 27(9):991–996CrossRefPubMed Camps JI (2011) The use of robotics in pediatric surgery: my initial experience. Pediatr Surg Int 27(9):991–996CrossRefPubMed
4.
go back to reference Luebbe BN, Woo R, Wolf S, Irish MS (2003) Robotically assisted minimally invasive surgery in a pediatric population: initial experience, technical considerations, and description of the da Vinci® surgical system. Pediat Endosurg Innov Tech 7(4):385CrossRef Luebbe BN, Woo R, Wolf S, Irish MS (2003) Robotically assisted minimally invasive surgery in a pediatric population: initial experience, technical considerations, and description of the da Vinci® surgical system. Pediat Endosurg Innov Tech 7(4):385CrossRef
5.
go back to reference Meehan JJ, Elliott S, Sandler A (2007) The robotic approach to complex hepatobiliary anomalies in children: preliminary report. J Pediatr Surg 42:2110–2114CrossRefPubMed Meehan JJ, Elliott S, Sandler A (2007) The robotic approach to complex hepatobiliary anomalies in children: preliminary report. J Pediatr Surg 42:2110–2114CrossRefPubMed
6.
go back to reference Cundy TP, Shetty K, Clark J, Chang TP, Sriskandarajah K, Gattas NE, Najmaldin A, Yang GZ, Darzi A (2013) The first decade of robotic surgery in children. J Pediatr Surg 48(4):858–865CrossRefPubMed Cundy TP, Shetty K, Clark J, Chang TP, Sriskandarajah K, Gattas NE, Najmaldin A, Yang GZ, Darzi A (2013) The first decade of robotic surgery in children. J Pediatr Surg 48(4):858–865CrossRefPubMed
8.
go back to reference De Lambert G, Fourcade L, Cent J (2013) How to successfully implement a robotic pediatric surgery program: lessons learned after 96 procedures. Surg Endosc 27:2137–2144CrossRefPubMed De Lambert G, Fourcade L, Cent J (2013) How to successfully implement a robotic pediatric surgery program: lessons learned after 96 procedures. Surg Endosc 27:2137–2144CrossRefPubMed
9.
go back to reference Dangle PP, Kearns J, Anderson B, Gundeti MS (2013) Outcomes of infants undergoing robot-assisted laparoscopic pyeloplasty compared to open repair. J Urol 190(6):2221–2227CrossRefPubMed Dangle PP, Kearns J, Anderson B, Gundeti MS (2013) Outcomes of infants undergoing robot-assisted laparoscopic pyeloplasty compared to open repair. J Urol 190(6):2221–2227CrossRefPubMed
10.
go back to reference Cabot JC, Lee CR, Brunaud L, Kleiman DA, Chung WY, Fahey TJ, Zarnegar R (2012) Robotic and endoscopic transaxillary thyroidectomies may be cost prohibitive when compared to standard cervical thyroidectomy: a cost analysis. Surgery 152(6):1016–1024CrossRefPubMed Cabot JC, Lee CR, Brunaud L, Kleiman DA, Chung WY, Fahey TJ, Zarnegar R (2012) Robotic and endoscopic transaxillary thyroidectomies may be cost prohibitive when compared to standard cervical thyroidectomy: a cost analysis. Surgery 152(6):1016–1024CrossRefPubMed
11.
go back to reference Anderberg M, Kockum CC, Arnbjornsson E (2009) Paediatric robotic surgery in clinical practice: a cost analysis. Eur J Pediatr Surg 19(5):311–315CrossRefPubMed Anderberg M, Kockum CC, Arnbjornsson E (2009) Paediatric robotic surgery in clinical practice: a cost analysis. Eur J Pediatr Surg 19(5):311–315CrossRefPubMed
12.
go back to reference Casella DP, Fox JA, Schneck FX, Cannon GM, Ost MC (2013) Cost analysis of pediatric robot-assisted and laparoscopic pyeloplasty. J Urol 189(3):1083–1086CrossRefPubMed Casella DP, Fox JA, Schneck FX, Cannon GM, Ost MC (2013) Cost analysis of pediatric robot-assisted and laparoscopic pyeloplasty. J Urol 189(3):1083–1086CrossRefPubMed
13.
go back to reference Chaussy Y, Becmeur F, Lardy H, Aubert D (2013) Robotic-assisted surgery: current status evaluation in abdominal and urological pediatric surgery. J Laparoendosc Adv Surg Tech A 23(6):530–538CrossRefPubMed Chaussy Y, Becmeur F, Lardy H, Aubert D (2013) Robotic-assisted surgery: current status evaluation in abdominal and urological pediatric surgery. J Laparoendosc Adv Surg Tech A 23(6):530–538CrossRefPubMed
15.
go back to reference AGENAS, Nucleo Tecnico Health Technology Assessment Regione Sicilia. Supporto consulenziale del NTHTA alla richiesta dell’A.R.N.A.S. Civico di Palermo sul Robot da Vinci; April 2013 AGENAS, Nucleo Tecnico Health Technology Assessment Regione Sicilia. Supporto consulenziale del NTHTA alla richiesta dell’A.R.N.A.S. Civico di Palermo sul Robot da Vinci; April 2013
16.
go back to reference Turchetti G, Palla I, Pierotta F, Cuschieri A (2012) Economic evaluation of Da Vinci-assisted robotic surgery: a systematic review. Surg Endosc 26:598–606CrossRefPubMed Turchetti G, Palla I, Pierotta F, Cuschieri A (2012) Economic evaluation of Da Vinci-assisted robotic surgery: a systematic review. Surg Endosc 26:598–606CrossRefPubMed
Metadata
Title
A comparative cost analysis of robotic-assisted surgery versus laparoscopic surgery and open surgery: the necessity of investing knowledgeably
Authors
Giorgia Tedesco
Francesco C. Faggiano
Erica Leo
Pietro Derrico
Matteo Ritrovato
Publication date
01-11-2016
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 11/2016
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-016-4852-7

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