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Health Economics Review

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Open Access 01-12-2023 | Prostate Cancer | Research

Robotic-assisted surgery for prostatectomy – does the diffusion of robotic systems contribute to treatment centralization and influence patients’ hospital choice?

Authors: David Kuklinski, Justus Vogel, Cornelia Henschke, Christoph Pross, Alexander Geissler

Published in: Health Economics Review | Issue 1/2023

Abstract

Background

Between 2008 and 2018, the share of robotic-assisted surgeries (RAS) for radical prostatectomies (RPEs) has increased from 3 to 46% in Germany. Firstly, we investigate if this diffusion of RAS has contributed to RPE treatment centralization. Secondly, we analyze if a hospital’s use of an RAS system influenced patients’ hospital choice.

Methods

To analyze RPE treatment centralization, we use (bi-) annual hospital data from 2006 to 2018 for all German hospitals in a panel-data fixed effect model. For investigating RAS systems’ influence on patients’ hospital choice, we use patient level data of 4614 RPE patients treated in 2015. Employing a random utility choice model, we estimate the influence of RAS as well as specialization and quality on patients’ marginal utilities and their according willingness to travel.

Results

Despite a slight decrease in RPEs between 2006 and 2018, hospitals that invested in an RAS system could increase their case volumes significantly (+ 82% compared to hospitals that did not invest) contributing to treatment centralization. Moreover, patients are willing to travel longer for hospitals offering RAS (+ 22% than average travel time) and for specialization (+ 13% for certified prostate cancer treatment centers, + 9% for higher procedure volume). The influence of outcome quality and service quality on patients’ hospital choice is insignificant or negligible.

Conclusions

In conclusion, centralization is partly driven by (very) high-volume hospitals’ investment in RAS systems and patient preferences. While outcome quality might improve due to centralization and according specialization, evidence for a direct positive influence of RAS on RPE outcomes still is ambiguous. Patients have been voting with their feet, but research yet has to catch up.

Available only for authorised users

We identify RPEs with the procedure code 5–604 from the German Operation and Procedure Catalogue (Operationen- und Prozedurenschlüssel, OPS).

From 2006 to 2012, structured quality reports were published bi-annually, from 2012 onward annually.

We identify robotic-assisted procedures with the OPS procedure code 5–987.

For the full list of centers see https://oncomap.de/centers

Recommendation is addressed by question no. 14: “Would you recommend this hospital to your best friend?”.

The average procedure volume per hospital of a hospital sub-group can be calculated by multiplying the sub-group’s procedure volume share with the total procedure volume and dividing the result by the number of hospitals in the respective hospital sub-group.

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Title: Robotic-assisted surgery for prostatectomy – does the diffusion of robotic systems contribute to treatment centralization and influence patients’ hospital choice?
Authors: David Kuklinski
Justus Vogel
Cornelia Henschke
Christoph Pross
Alexander Geissler
Publication date: 01-12-2023
Publisher: Springer Berlin Heidelberg
Keywords: Prostate Cancer
Prostate Cancer
Prostatectomy
Prostatectomy
Published in: Health Economics Review / Issue 1/2023
Electronic ISSN: 2191-1991
DOI: https://doi.org/10.1186/s13561-023-00444-9

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Springer Medicine

Robotic-assisted surgery for prostatectomy – does the diffusion of robotic systems contribute to treatment centralization and influence patients’ hospital choice?

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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