1228 COST ANALYSIS OF ROBOTIC-ASSISTED RADICAL CYSTECTOMY VERSUS OPEN RADICAL CYSTECTOMY UTILIZING A PROSPECTIVE, RANDOMIZED COHORT

Abstract

You have accessJournal of UrologyTechnology & Instruments: Robotics - Malignant Disease & Benign Disease I1 Apr 20121228 COST ANALYSIS OF ROBOTIC-ASSISTED RADICAL CYSTECTOMY VERSUS OPEN RADICAL CYSTECTOMY UTILIZING A PROSPECTIVE, RANDOMIZED COHORT Ian Udell, Raj Kurpad, Jed Fergueson, Angela Smith, Matthew Nielsen, Eric Wallen, Michael Woods, and Raj Pruthi Ian UdellIan Udell Chapel Hill, NC More articles by this author , Raj KurpadRaj Kurpad Chapel Hill, NC More articles by this author , Jed FerguesonJed Fergueson Chapel Hill, NC More articles by this author , Angela SmithAngela Smith Chapel Hill, NC More articles by this author , Matthew NielsenMatthew Nielsen Chapel Hill, NC More articles by this author , Eric WallenEric Wallen Chapel Hill, NC More articles by this author , Michael WoodsMichael Woods Chapel Hill, NC More articles by this author , and Raj PruthiRaj Pruthi Chapel Hill, NC More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1518AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Robotic-assisted radical cystectomy (RARC) holds promise to improve patient perioperative outcomes while maintaining oncologic outcomes relative to open radical cytectomy (ORC). However, the cost-benefits of the robotic approach are under debate. We evaluated the detailed cost estimates of RARC and ORC utilizing a prospectively randomized patient cohort. METHODS Over 10 months in 2008, 41 patients meeting inclusion criteria were randomized to either ORC (n=21) or RARC (n=20). Baseline demographic data, patient comorbidities, tumor characteristics, and perioperative outcomes were assessed. Real-world direct variable costs and allocated fixed costs including OR costs and hospital costs were obtained from hospital accounting and evaluated using parametric and non-parametric statistical analyses. Point estimates for RARC-specific OR capital expenses were calculated assuming 80% robot usage and subjected to sensitivity analysis. RESULTS There were no statistically significant differences between groups for median age (ORC 70 yrs vs RARC 70; p=0.6), age-adjusted Charlson comorbidity index (6.2 vs 4.9; p=0.09), or pathologic tumor stage (p=0.14). The median for overall cost was higher for RARC (see table) (p=0.14). Significant differences between the two cohorts were found for OR time (293 mins vs 389; p<0.001), and length of stay (LOS) (6.0 days vs 4.0; p=0.02) which resulted in higher OR fees and lower post-op hospital costs for the RARC group, respectively. OR capital expenses and OR disposable costs were higher for the RARC group. Median transfusion costs were lower for RARC group ($98 vs $448; p=0.002). CONCLUSIONS Utilizing subjects enrolled in prospective randomized trial of ORC vs. RARC, the overall costs between RARC and ORC were not statistically different. RARC requires significant capital expenditure, longer OR times, and higher OR disposable costs in relation to ORC, while RARC patients have a significant decrease in LOS and post-op hospital costs. Future studies should aim to include differential costs due to time to convalescence to complete the cost analysis from the societal perspective. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e497 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ian Udell Chapel Hill, NC More articles by this author Raj Kurpad Chapel Hill, NC More articles by this author Jed Fergueson Chapel Hill, NC More articles by this author Angela Smith Chapel Hill, NC More articles by this author Matthew Nielsen Chapel Hill, NC More articles by this author Eric Wallen Chapel Hill, NC More articles by this author Michael Woods Chapel Hill, NC More articles by this author Raj Pruthi Chapel Hill, NC More articl