Cost-analysis comparison of robot-assisted laparoscopic radical cystectomy (RC) vs open RC
Cost-analysis comparison of robot-assisted laparoscopic radical cystectomy (RC) vs open RC
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DOI：
10.1111/j.1464-410x.2011.10468.x
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发表时间：
2011-09-01
影响因子：
4.5
通讯作者：
Scherr, Douglas S.
中科院分区：
文献类型：
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作者：
Lee, Richard;Chughtai, Bilal;Scherr, Douglas S.
目的系统回顾和比较开放根治性膀胱切除术 (ORC) 与机器人辅助腹腔镜根治性膀胱切除术 (RALRC) 联合盆腔淋巴结清扫术和尿流改道术的经济负担。 患者和方法 通过 Medline 搜索来查找有关 RC 和尿流改道术的英文文章。由此产生的文章进一步受到术语“腹腔镜”、“机器人”或“机器人辅助”的限制。总共确定了三篇文章。然后，除了住院时间 (LOS)、手术持续时间和并发症发生率等相关临床变量外，还收集了每篇文章的成本绩效数据。如果可能，数据按回肠导管 (IC)、大陆皮肤改道 (CCD) 和原位新膀胱 (ON) 亚组进行细分。确定了 ORC 或 RALRC 伴随住院治疗产生的直接费用。考虑并发症的间接成本。结果尽管材料成本增加，但考虑并发症成本时，RALRC 比 ORC 便宜。对于 IC 和 CCD，RALRC 比 ORC 便宜，但 ON 的成本优势恶化。已发表数据中引用的最大成本驱动因素是 LOS、手术持续时间和每日住院费用。与 ORC 相比，RALRC 表现出更短的 LOS，尽管这种效应不足以抵消机器人手术增加的成本。并发症受到重大影响性价比。结论：尽管材料成本增加，但当考虑到并发症的影响时，RALRC 作为膀胱癌的治疗方法比 ORC 更具成本效益。这种效果对于接受 IC 的患者最为明显。
OBJECTIVETo systematically review and compare the economic burden of open radical cystectomy (ORC) vs robot-assisted laparoscopic radical cystectomy (RALRC) with pelvic lymph node dissection and urinary diversion.PATIENTS AND METHODSA Medline search was conducted to identify English language articles regarding RC with urinary diversion. The resulting articles were then further restricted by the terms 'laparoscopic', 'robotic', or 'robotic-assisted'. In all, three articles were identified.Data from each of these articles were then collected on cost performance in addition to relevant clinical variables, such as length of stay (LOS), operative duration, and complication rates.When possible, data were subdivided by ileal conduit (IC), continent cutaneous diversion (CCD), and orthotopic neobladder (ON) subgroups.Direct costs resulting from ORC or RALRC with accompanying hospitalization were identified. The indirect costs of complications were considered.RESULTSDespite an increased materials cost, RALRC was less expensive than ORC when the cost of complications was considered.RALRC was less expensive than ORC for IC and CCD, but the cost advantage deteriorated for ON.The largest cost drivers cited in the published data were LOS, operative durations, and daily hospitalizations costs.RALRC demonstrated shorter LOS compared with ORC, although this effect was insufficient to offset the increased cost of robotic surgery.Complications materially affected cost performance.CONCLUSIONSDespite an increased materials cost, RALRC can be more cost efficient than ORC as a treatment for bladder cancer when the impact of complications are considered.This effect is most pronounced for patients undergoing IC.