Navigation Links
Robotic-assisted prostate cancer surgery drives up costs, UPMC study finds

PITTSBURGH, May 23 In one of the most comprehensive analyses to date of the cost of robotic-assisted, laparoscopic surgery for prostate cancer, researchers at UPMC found that this now-dominant surgical approach is significantly more costly than standard open surgery, despite little scientific evidence of long-term improved patient outcomes. The results of the study are available online and will appear in the July issue of the journal Urology.

In one of the first studies based on actual direct and indirect costs at a single institutionrather than computer models that evaluate theoretical coststhe researchers found that the mean total cost per case of robotic-assisted laparoscopic radical prostatectomy (RARP) exceeded by 62 percent the cost of open radical retropubic prostatectomy (RRP). There was no significant difference in the mean length of stay for patients undergoing RARP vs. RRP, 1.2 and 1.4 days, respectively.

Since payment to the hospital was nearly equivalent for both types of procedures, the hospital lost $4,013 on average for each RARP case, while the payments exceeded costs by $1,325 for the standard open approach. Most of the cost difference, researchers found, was attributable to the robotic equipment and supplies.

"Nearly 240,000 new cases of prostate cancer are diagnosed annually, and radical prostatectomy is the most common treatment," said Joel B. Nelson, M.D., senior author of the study and chairman of the Department of Urology at UPMC and the University of Pittsburgh School of Medicine. "The value of that care for patients is of particular concern to a nation struggling to control health care costs while improving outcomes." During the past decade, he noted, RARP has become the dominant surgical approach in the treatment of prostate cancer, with a surgeon controlling a robot's arms remotely to remove cancerous organs through small incisions in the patient's abdomen. Yet there is limited data to show that this technological innovation has produced better long-term patient results. "It is reasonable to question whether the increased costs of this robotic-assisted approach are justified," said Dr. Nelson, who is also co-director of the University of Pittsburgh Cancer Institute's Prostate Cancer Program.

For their cost analysis, the researchers looked at the treatment of 473 consecutive patients from July 2009 to October 2010 at UPMC Shadyside hospital. Four urologic oncologists with considerable experience in RARP and RRP operated on these patients, using RARP for 115 and RRP for 358.

The overall cost per case for RARP exceeded the cost for RRP by almost $5,300. The major contributors to the cost gap were greater operating room supply costs and indirect costs associated with the purchase and maintenance of the robotic equipment. Operating room supply costs were almost seven times greater for RARP, while ancillary, cardiology, imaging, administrative, laboratory and pharmacy costs were not significantly different between the two approaches.

Several previous studies also have demonstrated a cost advantage for the standard open surgical approach. However, those studies sometimes excluded certain costs or involved hospitals with lower surgical volumes or surgeons who were less experienced with the robotic-assisted technology, potentially skewing the cost per case.

Dr. Nelson noted that randomized clinical trialsthe gold standard in scientific researchcomparing RRP and RARP are lacking. But a recent review of 37 comparative prostatectomy studies found no superiority for one approach vs. the other in terms of functional (such as post-operative continence and potency) and oncologic outcomes for patients.

"While further studies are needed to compare the long-term outcomes of RRP vs. RARP, our study suggests that our society may be paying too high a price for what has been widely perceived as a medical advance," said Dr. Nelson.

Contact: Wendy Zellner
University of Pittsburgh Schools of the Health Sciences

Related medicine news :

1. Researchers find anatomic differences after robotic-assisted radical prostatectomy
2. Prostate cancer patients treated with robotic-assisted surgery can expect low recurrence of cancer
3. Robotic-assisted vasectomy reversal offers greater chance of fatherhood
4. Psychological Science explains uproar over prostate-cancer screenings
5. Scientists unravel role of fusion gene in prostate cancer
6. U.S. Advisers Say No to Routine PSA Tests for Prostate Cancer
7. Study Ties Genes to Lower Urinary Tract Symptoms, Prostate Cancer Risk
8. Do Bald Men Face Higher Risk of Prostate Cancer?
9. Statins May Help Prevent Enlarged Prostate: Study
10. Scientists discover distinct molecular subtype of prostate cancer
11. Protein RAL associated with aggressive characteristics in prostate, bladder and skin cancers
Post Your Comments:
(Date:11/27/2015)... ... November 27, 2015 , ... The moment you stop improving ... only fulfilling the needs of advisers and clients but going above and beyond ... top-tier customer service. However, there's always room for improvement, which is why the ...
(Date:11/27/2015)... ... November 27, 2015 , ... Avid collector, Andrew Hawley from Vintage Rock Posters, ... posters. This is one of Joplin's most famous and beautiful concert posters. The concert ... Michigan in Ann Arbor. The According to Hawley, "It is hard to believe that ...
(Date:11/26/2015)... ... 26, 2015 , ... Somu Sivaramakrishnan announced today that he ... now offers travelers, value and care based Travel Services, including exclusive pricing on ... as, cabin upgrades and special amenities such as, shore excursions, discounted fares, travel ...
(Date:11/26/2015)... ... November 26, 2015 , ... Pixel Film Studios brings Final ... ProTrailer: Vintage. This newly styled ProTrailer pack comes with 30 all-new vintage-inspired designs, ... giving users limitless opportunities to stylize and create designs quickly and easily, all ...
(Date:11/25/2015)... ... ... The holiday season is jam-packed with family dinners, parties ... is of the utmost importance. Whether you are cooking at home for the ... try this holiday season. , Turkey Croquettes ,     Ingredients: , ...
Breaking Medicine News(10 mins):
(Date:11/26/2015)... November 26, 2015 ... adds "Global Repaglinide Industry ... Report on China Repaglinide Market, 2010-2019" ... data and information to its online ... . --> ...
(Date:11/26/2015)... 26, 2015 Research and Markets ( ... "2016 Future Horizons and Growth Strategies in ... Shares, Country Segment Forecasts, Competitive Intelligence, Emerging Opportunities" ... --> --> This new ... Italian therapeutic drug monitoring market, including emerging tests, ...
(Date:11/26/2015)... DUBLIN , November 26, 2015 ... has announced the addition of the  ... in the European Cell Surface Marker ... Emerging Opportunities"  report to their offering.  ... announced the addition of the  "2016 ...
Breaking Medicine Technology: