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World J Clin Urol. Mar 24, 2016; 5(1): 24-28
Published online Mar 24, 2016. doi: 10.5410/wjcu.v5.i1.24
Cost effectiveness of robot-assisted urologic oncological surgery in the United States
Catherine J Chen, Mitchell R Humphreys
Catherine J Chen, Mitchell R Humphreys, Department of Urology, Mayo Clinic Arizona, Phoenix, AZ 85054, United States
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: There is no conflict of interest associated with the senior author or coauthors in writing this manuscript or the content of this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Mitchell R Humphreys, MD, Department of Urology, Mayo Clinic Arizona, 5777 E. Mayo Blvd., Phoenix, AZ 85054, United States. humphreys.mitchell@mayo.edu
Telephone: +1-480-3422793 Fax: +1-480-3422799
Received: August 28, 2015
Peer-review started: September 5, 2015
First decision: November 24, 2015
Revised: December 24, 2015
Accepted: January 5, 2016
Article in press: January 7, 2016
Published online: March 24, 2016
Processing time: 202 Days and 20.2 Hours
Abstract

Urology has been on the forefront of technological advances in minimally invasive surgery, from laparoscopy to robot-assisted surgeries. As with all new technological advances in medicine, the results of new advances are compared to previously established gold standards. When it comes to robot-assisted urology, morbidity, oncological outcomes, and cost between the same surgeries performed in an open fashion vs with robot-assistance should be assessed. Because healthcare spending is increasingly under more scrutiny, there is debate on the cost effectiveness of robot-assisted surgeries given the high acquisition and maintenance cost of robotic systems. This articles aims to critically evaluate the cost effectiveness of robot-assisted surgeries for prostatectomies, cystectomies, and partial nephrectomies in the United States.

Keywords: Cost-effectiveness; Robot; Prostatectomy; Cystectomy; Partial nephrectomy

Core tip: Robot-assisted urologic oncologic surgeries offers significant amounts of benefit, with shorter length of stay, less blood loss and improved peri-operative quality of life. The high fixed cost of robot acquisition and maintenance is offset by increasing the number of robot cases per year, narrowing the gap in cost between robot-assisted surgeries and open surgeries. Cost effective analysis and cost benefit analysis of robot-assisted surgeries are difficult to assess given the difficulties with evaluating indirect costs. However, the measurable differences favor robot-assisted surgeries.