Cost Comparison of Robotic, Laparoscopic, and Open Radical Prostatectomy for Prostate Cancer
Cost Comparison of Robotic, Laparoscopic, and Open Radical Prostatectomy for Prostate Cancer
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DOI：
10.1016/j.eururo.2009.11.008
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发表时间：
2010-03-01
期刊：
影响因子：
23.4
通讯作者：
Lotan, Yair
中科院分区：
文献类型：
--
作者：
Bolenz, Christian;Gupta, Amit;Lotan, Yair
工作背景：近年来，微创根治性直肠癌切除术的需求和使用有所增加，但缺乏成本方面的比较研究。目的：比较机器人辅助腹腔镜根治性直肠癌切除术（RALP）、腹腔镜根治性直肠癌切除术（LRP）和开放性耻骨后根治性直肠癌切除术（RRP）的相关成本。设计、设置和参与者：该研究纳入了2003年9月至2008年4月期间接受根治性直肠癌切除术的643例连续患者（262例RALP，220例LRP和161例RRP）。结果和局限性：疾病特征（体重指数，术前前列腺特异性抗原，前列腺大小和Gleason总分8-10）在三组中相似。在85%的RALP手术、96%的LRP手术和90%的RRP手术中进行了神经保留（p < 0.001）。与LRP（22%）和RALP（11%）相比，RRP（100%）更常进行淋巴结切除术（p < 0.001）。RRP的平均住院时间高于LRP和RALP。RALP的直接成本中位数高于LRP或RRP（RALP：6752美元[四分位数间距（IQR）：6283 -7369美元]; LRP：5687美元[IQR：4941 -5905美元]; RRP：4437美元[IQR：3989 -5141美元]; p < 0.001）。主要差异在于手术供应成本（RALP：2015美元; LRP：725美元; RRP：185美元）和手术室（OR）成本（RALP：2798美元; LRP：2453美元; RRP：1611美元; p < 0.001）。当考虑购买和维护成本的机器人，经济负担将增加2698美元，每名患者，平均每年126例。结论：RALP与更高的成本，主要是由于增加手术供应和OR成本。这些费用可能对前列腺癌护理的总成本产生重大影响。(C)2009年欧洲泌尿外科协会。Elsevier B. V.出版，保留所有权利。
Background: Demand and utilization of minimally invasive approaches to radical prostatectomy have increased in recent years, but comparative studies on cost are lacking.Objective: To compare costs associated with robotic-assisted laparoscopic radical prostatectomy (RALP), laparoscopic radical prostatectomy (LRP), and open retropubic radical prostatectomy (RRP).Design, setting, and participants: The study included 643 consecutive patients who underwent radical prostatectomy (262 RALP, 220 LRP, and 161 RRP) between September 2003 and April 2008.Measurements: Direct and component costs were compared. Costs were adjusted for changes over the time of the study.Results and limitations: Disease characteristics (body mass index, preoperative prostate-specific antigen, prostate size, and Gleason sum score 8-10) were similar in the three groups. Nerve sparing was performed in 85% of RALP procedures, 96% of LRP procedures, and 90% of RRP procedures (p < 0.001). Lymphadenectomy was more commonly performed in RRP (100%) compared to LRP (22%) and RALP (11%) (p < 0.001). Mean length of hospital stay was higher for RRP than for LRP and RALP. The median direct cost was higher for RALP compared to LRP or RRP (RALP: $6752 [interquartile range (IQR): $6283-7369]; LRP: $5687 [IQR: $4941-5905]; RRP: $4437 [IQR: $3989-5141]; p < 0.001). The main difference was in surgical supply cost (RALP: $2015; LRP: $725; RRP: $185) and operating room (OR) cost (RALP: $2798; LRP: $2453; RRP: $1611; p < 0.001). When considering purchase and maintenance costs for the robot, the financial burden would increase by $2698 per patient, given an average of 126 cases per year.Conclusions: RALP is associated with higher cost, predominantly due to increased surgical supply and OR costs. These costs may have a significant impact on overall cost of prostate cancer care. (C) 2009 European Association of Urology. Published by Elsevier B.V. All rights reserved.