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. Nel
|Contact: Wendy Zellner |
University of Pittsburgh Schools of the Health Sciences