Cost Analysis of conventional Laparoscopic pyeloplasty (CLP) versus Robotic assisted laparoscopic pyeloplasty (RALP) at a single center study
Laparoscopic pyeloplasty is the standard of care for the ureteropelvic junction obstruction (UPJO) correction in several hospital (1).
Several cost analysis, in which common robot-assisted procedures such as radical prostatectomy, partial nephrectomy and radical cystectomy were analysed, revealed higher costs with robotic procedures (2-3).
The aim of this study was to compare the costs of conventional laparoscopic pyeloplasty (CLPP) and robotic-assisted laparoscopic pyeloplasty (RALPP) (4), which are both used for correction of UPJO at our institution from January 2016.
Materials and Methods
We retrospectively identified 11 consecutive RALPP (Group A) and 19 consecutive CLPP (Group B) performed at our institution between January 2016 and December 2016. 2 out of the 19 CLPP patients underwent laparoscopic redo pyeloplasty for recurrent UPJO. All procedures were performed by a single surgical team with a transperitoneal approach.
The costs of each procedure include: 105.45€ for preospedalization phase, 307.23€ for each hour of use of operatory room (nursing and surgical team), 237.98€ for medical devices (surgical sutures, surgicl gloves, etc), 86.08€ for anesthetic drugs, 514.00€ for each day of hospitalization, 21.06€ for each postoperative blood sample, 56.80€ for stenting removal. The cost of the Robotic Da Vinci Xi system with the use of 3 robotics arms is 4.382,24€ and with 4 robotics arms is 5.159,38€.
Th costs related to the laparoscopic instruments for the CLPP is 301,08€.
The regional refund for this kind of surgical procedure is 8.530€ .
The mean operating room operation time in the Group A was 126.36 minutes and in the Group B was 117.36 minutes. The mean length of hospital stay was 3.36 days in the Group A and 3.42 days in the Group B. The mean postoperative blood sample was 1.63 samples in the Group A and 1.73 samples in the Group B. In Group A, seven procedures were performed with four robotics arms and four procedures with three robotics arms. No intraoperative and postoperative complications that caused adjunctive costs occurred and no patients experienced early failure of the procedure.
As a consequence, the global cost of the eleven RALPPs at our department was 85486,1€ (mean 7.771,46€) and the global costs of the nineteen CLPPs in our hospital was 60.510,58€ (mean 3.184,74).
In our experience there are greater costs for robotic instrumentation but not for medical and nurse surgical team. Moreover the mean operating room operation time and the mean length of hospital stay were similar in the two groups. The global profit related to RALPP was 8343.9€ and the profit related to CLPP was 101.559,42€.
Moreover, in this first prelimary experience we have not considered the costs related to robotic platform maintenance contracts (200.000€), because at our hospital the maintenance of the robotic platform has been free for the first year.
It is possible in the future to achieve a more profit in the RALPP considering a shorter operative times due to the improvement of our robotic learning curve and considering a shorter time of dismission.
In addition to the costs of the surgical procedure and perioperative care, the costs of long-term follow-up and care must be considered when comparing these 2 procedures. Long term followup data are not yet available.
Our preliminary single institutional analysis shows bigger costs for the robotic-assisted laparoscopic pyeloplasty and as a consequence a better profit for the conventional laparoscopic pyeloplasty. It remains the best cost-effective procedure in the treatment of UPJO.
1- Fedelini P, Verze P, Meccariello C, Arcaniolo D, Taglialatela D, Mirone VG. Intraoperative and postoperative complications of laparoscopic pyeloplasty: a single surgical team experience with 236 cases. J Endourol. 2013 Oct;27(10):1224-9.
2- Lotan Y, Cadeddu JA and Gettman MT: The new economics of radical prostatectomy: cost comparison of open, laparoscopic and robot assisted techniques. J Urol 2004; 172: 1431.
3-. Mir SA, Cadeddu JA, Sleeper JP et al: Cost comparison of robotic, laparoscopic, and open partial nephrectomy. J Endourol 2011; 25: 447.
4- Yee DS, Shanberg AM, Duel BP et al: Initial comparison of robotic-assisted laparoscopic versus open pyeloplasty in children. Urology 2006; 67: 599.