76 NOT A ZERO-SUM GAME: THE ADOPTION OF ROBOTICS HAS INCREASED OVERALL PROSTATECTOMY UTILIZATION IN THE UNITED STATES

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness1 Apr 201176 NOT A ZERO-SUM GAME: THE ADOPTION OF ROBOTICS HAS INCREASED OVERALL PROSTATECTOMY UTILIZATION IN THE UNITED STATES Hugh Lavery, David Samadi, and Adam Levinson Hugh LaveryHugh Lavery New York, NY More articles by this author , David SamadiDavid Samadi New York, NY More articles by this author , and Adam LevinsonAdam Levinson New York, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.140AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The vast majority of American men with localized prostate cancer receive definitive treatment. Within this milieu, the rapid adoption of robotic prostatectomy has had a substantial impact on the management of localized prostate cancer. We intended to assess whether the shift from open to robotic prostatectomy during the last decade affected the overall volume of prostatectomies performed in the United States. METHODS National prostatectomy volume was obtained from the Healthcare Cost and Utilization Project from 1997 to 2008. “Prostatectomy volume” was defined as the number of annual hospital discharges for the principal procedure ICD-9-CM code of 60.5 (radical prostatectomy). Prostate cancer incidence rates from 1997 to 2007 were obtained from the SEER 13 dataset. Robotic prostatectomy procedural volume from 2003 to 2008 was obtained from publically-available Intuitive Surgical investor information. Rates were calculated in the periods 1997–2004 and 2005–2008 to represent the “pre-robotic” and “robotic” eras, respectively. Annualized rates were obtained with linear regression. RESULTS From 1997 to 2008, the overall incidence of prostate cancer decreased by 2.2 cases/100,000 men (p=0.009). During these years the overall rate of prostatectomy increased at a rate of 1692 cases/year (p=0.05), to a high of 87,675 in 2008 (r2=0.34) (figure 1). However, from 1997-2004 the prostatectomy rate remained stable at approximately 60,000/year. The increase in volume occurred during the “robotic era” beginning in 2005. From 2005 to 2008, overall prostatectomy volume increased at a rate of 11,243 cases/year (p=0.005) in a highly consistent manner (r2=0.99). In the same time period, there was a rapid increase in RALPs, from approximately 9,000/year in 2004 to 72,000/year in 2008. CONCLUSIONS From a relatively constant volume of men with incident localized prostate cancer, the overall utilization of surgical therapy increased in the period starting in 2005, concomitant with the propagation of robotic technology. It is therefore likely that a greater proportion of patients are electing prostatectomy over competing treatment modalities. This migration may have profound consequences both in terms of cancer outcomes and fiscal policy. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byPatel H, Humphreys E, Trock B, Han M and Carter H (2018) Practice Patterns and Individual Variability of Surgeons Performing Radical Prostatectomy at a High Volume Academic CenterJournal of Urology, VOL. 193, NO. 3, (812-819), Online publication date: 1-Mar-2015. Volume 185Issue 4SApril 2011Page: e33 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Hugh Lavery New York, NY More articles by this author David Samadi New York, NY More articles by this author Adam Levinson New York, NY More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...