An economic analysis of robotically assisted hysterectomy.
An economic analysis of robotically assisted hysterectomy.
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DOI：
10.1097/aog.0000000000000244
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发表时间：
2014-05
影响因子：
7.2
通讯作者：
Hershman DL
中科院分区：
文献类型：
--
作者：
Wright JD;Ananth CV;Tergas AI;Herzog TJ;Burke WM;Lewin SN;Lu YS;Neugut AI;Hershman DL
进行计量经济学分析，以检查手术量的影响，医院会计方法的变化，以及使用各种分析方法对良性妇科疾病和子宫内膜癌的机器人辅助子宫切除术的成本。一个全国性的样本被用来识别从2006年到2012年因良性适应症或子宫内膜癌而接受腹腔镜或机器人辅助子宫切除术的妇女。外科医生和医院数量分类为首次手术前进行的手术数量。采用多变量分位数回归方法对总成本以及固定和可变成本进行建模。共确定了180，230名妇女，包括169，324名因良性适应症接受微创子宫切除术的妇女和10，906名因子宫内膜癌接受子宫切除术的患者。机器人辅助子宫切除术治疗良性适应症的未调整中位成本为8，152美元（四分位数范围[IQR] 6，011 - 10，932美元），而腹腔镜子宫切除术为6，535美元（IQR 5，127 - 8，357美元）（P <.001）。成本差异随着外科医生和医院数量的增加而下降。子宫内膜癌机器人辅助子宫切除术的未调整中位成本为9，691美元（IQR $7，591 - 12，428），而腹腔镜子宫切除术为8，237美元（IQR $6，400 - 10，807）（P <.001）。随着医院数量的增加，费用差异从最初5至15例的2 471美元下降到50例以上的924美元。根据外科医生的工作量，对于那些做过少于5例手术的人来说，机器人辅助子宫内膜癌切除术比腹腔镜手术贵1,761美元;与腹腔镜子宫切除术相比，50多例手术的差异下降到688美元。机器人妇科手术的成本随着手术量的增加而降低。然而，在所有模拟的情况下，机器人辅助子宫切除术仍然比腹腔镜子宫切除术昂贵得多。
To perform an econometric analysis to examine the influence of procedure volume, variation in hospital accounting methodology, and use of various analytic methodologies on cost of robotically assisted hysterectomy for benign gynecologic disease and endometrial cancer. A national sample was used to identify women who underwent laparoscopic or robotically assisted hysterectomy for benign indications or endometrial cancer from 2006 to 2012. Surgeon and hospital volume were classified as the number of procedures performed before the index surgery. Total costs as well as fixed and variable costs were modeled using multivariable quantile regression methodology. A total of 180,230 women, including 169,324 women who underwent minimally invasive hysterectomy for benign indications and 10,906 patients whose hysterectomy was performed for endometrial cancer, were identified. The unadjusted median cost of robotically assisted hysterectomy for benign indications was $8,152 (interquartile range [IQR] $6,011–10,932) compared with $6,535 (IQR $5,127–8,357) for laparoscopic hysterectomy (P<.001). The cost differential decreased with increasing surgeon and hospital volume. The unadjusted median cost of robotically assisted hysterectomy for endometrial cancer was $9,691 (IQR $7,591–12,428) compared with $8,237 (IQR $6,400–10,807) for laparoscopic hysterectomy (P<.001). The cost differential decreased with increasing hospital volume from $2,471 for the first 5 to 15 cases to $924 for more than 50 cases. Based on surgeon volume, robotically assisted hysterectomy for endometrial cancer was $1,761 more expensive than laparoscopy for those who had performed fewer than five cases; the differential declined to $688 for more than 50 procedures compared with laparoscopic hysterectomy. The cost of robotic gynecologic surgery decreases with increased procedure volume. However, in all of the scenarios modeled, robotically assisted hysterectomy remained substantially more costly than laparoscopic hysterectomy.