Background: The economic value of robotic-assisted laparoscopic prostatectomy (RALP) in the United States is still not well understood because of limited view analyses. Objectives: The objective of this study was to examine the costs and benefits of RALP versus retropubic radical prostatectomy from an expanded view, including hospital, payer, and societal perspectives. Methods: We performed a model based cost comparison using clinical outcomes obtained from a systematic review of the published literature. Equipment costs were obtained from the manufacturer of the robotic system; other economic model parameters were obtained from government agencies, online resources, commercially available databases, an advisory expert panel, and the literature. Clinical point estimates and care pathways based on National Comprehensive Cancer Network guidelines were used to model costs out to 3 years. Hospital costs and costs incurred for the patients' postdischarge complications, adjuvant and salvage radiation treatment, incontinence and potency treatment, and lost wages during recovery were considered. Robotic system costs were modeled in two ways: as hospital overhead (hospital overhead calculation: RALP-H) and as a function of robotic case volume (robotic amortization calculation: RALP-R). All costs were adjusted to year 2014 US dollars. Results: Because of more favorable clinical outcomes over 3 years, RALP provided hospital ($1094 savings with RALP-H, $341 deficit with RALP-R), payer ($1451), and societal ($1202) economic benefits relative to retropubic radical prostatectomy. Conclusions: Monte-Carlo probabilistic sensitivity analysis demonstrated a 38% to 99% probability that RALP provides cost savings (depending on the perspective). Higher surgical consumable costs are offset by a decreased hospital stay, lower complication rate, and faster return to work.
机构:
UCLA, David Geffen Sch Med, Dept Urol, Inst Urol Oncol, Los Angeles, CA 90095 USAUCLA, David Geffen Sch Med, Dept Urol, Inst Urol Oncol, Los Angeles, CA 90095 USA
Laviana, A. A.
Hu, J. C.
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UCLA, David Geffen Sch Med, Dept Urol, Inst Urol Oncol, Los Angeles, CA 90095 USAUCLA, David Geffen Sch Med, Dept Urol, Inst Urol Oncol, Los Angeles, CA 90095 USA
机构:
Department of Urology, Georgetown University Hospital, 3800 Reservoir Rd NW, 1 PHC, WA, DCDepartment of Urology, Georgetown University Hospital, 3800 Reservoir Rd NW, 1 PHC, WA, DC
Kowalczyk K.J.
Huang A.C.
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机构:
Department of Urology, Taipei City Hospital-Renai Branch, TaipeiDepartment of Urology, Georgetown University Hospital, 3800 Reservoir Rd NW, 1 PHC, WA, DC
Huang A.C.
Williams S.B.
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Division of Urologic Oncology, The Center for Cancer Prevention and Treatment at St. Joseph Hospital, Orange, CADepartment of Urology, Georgetown University Hospital, 3800 Reservoir Rd NW, 1 PHC, WA, DC
Williams S.B.
Yu H.-Y.
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Department of Urology, Kaiser Permanente, Oakland Medical Center, Oakland, CADepartment of Urology, Georgetown University Hospital, 3800 Reservoir Rd NW, 1 PHC, WA, DC
Yu H.-Y.
Hu J.C.
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Department of Urology, David Geffen Medical School, University of California-Los Angeles, Los Angeles, CADepartment of Urology, Georgetown University Hospital, 3800 Reservoir Rd NW, 1 PHC, WA, DC
机构:
BP A Beneficencia Portuguesa Sao Paulo, Dept Urooncol, Rua Martiniano Carvalho 965, BR-01323030 Sao Paulo, SP, Brazil
ACCamargo Canc Ctr, Div Urol, Sao Paulo, BrazilBP A Beneficencia Portuguesa Sao Paulo, Dept Urooncol, Rua Martiniano Carvalho 965, BR-01323030 Sao Paulo, SP, Brazil
de Oliveira, Renato Almeida Rosa
Guimaraes, Gustavo Cardoso
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BP A Beneficencia Portuguesa Sao Paulo, Head Surg Oncol, Sao Paulo, BrazilBP A Beneficencia Portuguesa Sao Paulo, Dept Urooncol, Rua Martiniano Carvalho 965, BR-01323030 Sao Paulo, SP, Brazil
Guimaraes, Gustavo Cardoso
Mourao, Thiago Camelo
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BP A Beneficencia Portuguesa Sao Paulo, Dept Urooncol, Rua Martiniano Carvalho 965, BR-01323030 Sao Paulo, SP, BrazilBP A Beneficencia Portuguesa Sao Paulo, Dept Urooncol, Rua Martiniano Carvalho 965, BR-01323030 Sao Paulo, SP, Brazil
Mourao, Thiago Camelo
de Lima Favaretto, Ricardo
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BP A Beneficencia Portuguesa Sao Paulo, Dept Urooncol, Rua Martiniano Carvalho 965, BR-01323030 Sao Paulo, SP, BrazilBP A Beneficencia Portuguesa Sao Paulo, Dept Urooncol, Rua Martiniano Carvalho 965, BR-01323030 Sao Paulo, SP, Brazil
de Lima Favaretto, Ricardo
Santana, Thiago Borges Marques
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BP A Beneficencia Portuguesa Sao Paulo, Dept Urooncol, Rua Martiniano Carvalho 965, BR-01323030 Sao Paulo, SP, Brazil
ACCamargo Canc Ctr, Div Urol, Sao Paulo, BrazilBP A Beneficencia Portuguesa Sao Paulo, Dept Urooncol, Rua Martiniano Carvalho 965, BR-01323030 Sao Paulo, SP, Brazil
Santana, Thiago Borges Marques
Lopes, Ademar
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ACCamargo Canc Ctr, Head Pelv Surg Dept, Sao Paulo, BrazilBP A Beneficencia Portuguesa Sao Paulo, Dept Urooncol, Rua Martiniano Carvalho 965, BR-01323030 Sao Paulo, SP, Brazil
Lopes, Ademar
de Cassio Zequi, Stenio
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ACCamargo Canc Ctr, Head Urol Div, Sao Paulo, BrazilBP A Beneficencia Portuguesa Sao Paulo, Dept Urooncol, Rua Martiniano Carvalho 965, BR-01323030 Sao Paulo, SP, Brazil