Mouraviev Vladimir, Nosnik Israel, Sun Leon, Robertson Cary N, Walther Philip, Albala David, Moul Judd W, Polascik Thomas J
Duke Prostate Center and Division of Urologic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
Urology. 2007 Feb;69(2):311-4. doi: 10.1016/j.urology.2006.10.025.
To evaluate the financial implications of how the costs of new minimally invasive surgery such as laparoscopic robotic prostatectomy (LRP) and cryosurgical ablation of the prostate (CAP) technologies compare with those of conventional surgery.
From January 2002 to July 2005, 452 consecutive patients underwent surgical treatment for clinically localized (Stage T1-T2) prostate cancer. The distribution of patients among the surgical procedures was as follows: group 1, radical retropubic prostatectomy (RRP) (n = 197); group 2, radical perineal prostatectomy (RPP) (n = 60); group 3, LRP (n = 137); and group 4, CAP (n = 58). The total direct hospital costs and grand total hospital costs were analyzed for each type of surgery.
The mean length of stay in the CAP group was significantly lower (0.16 +/- 0.14 days) than that for RRP (2.79 +/- 1.46 days), RPP (2.87 +/- 1.43 days), and LRP (2.15 +/- 1.48 days; P <0.0005). The direct surgical costs were less for the RRP (2471 dollars +/- 636 dollars) and RPP (2788 dollars +/- 762 dollars) groups than for the technology-dependent procedures: LRP (3441 dollars +/- 545 dollars) and CAP (5702 dollars +/- 1606 dollars; P <0.0005). The total hospital cost differences, including pathologic assessment costs, were less for LRP (10,047 dollars +/- 107 dollars, median 9343 dollars) and CAP (9195 dollars +/- 1511 dollars, median 8796 dollars) than for RRP (10,704 dollars +/- 3468 dollars, median 9724 dollars) or RPP (10,536 dollars +/- 3088 dollars, median 9251 dollars), with significant differences (P <0.05) between the minimally invasive technique and open surgery groups.
In our study, despite the relatively increased surgical expense of CAP compared with conventional surgical prostatectomy (RRP or RPP) and LRP, the overall direct costs were offset by the significantly lower nonoperative hospital costs. The cost advantages associated with CAP included a shorter length of stay in the hospital and the absence of pathologic costs and the need for blood transfusion.
评估诸如腹腔镜机器人前列腺切除术（LRP）和前列腺冷冻消融术（CAP）等新型微创手术的成本与传统手术成本相比所产生的财务影响。
2002年1月至2005年7月，452例连续性患者接受了针对临床局限性（T1 - T2期）前列腺癌的手术治疗。手术方式的患者分布如下：第1组，耻骨后根治性前列腺切除术（RRP）（n = 197）；第2组，会阴根治性前列腺切除术（RPP）（n = 60）；第3组，LRP（n = 137）；第4组，CAP（n = 58）。分析了每种手术类型的医院直接总成本和医院总费用。
CAP组的平均住院时间显著低于RRP组（2.79 ± 1.46天）、RPP组（2.87 ± 1.43天）和LRP组（2.15 ± 1.48天；P <0.0005），为0.16 ± 0.14天。RRP组（2471美元 ± 636美元）和RPP组（2788美元 ± 762美元）的直接手术成本低于依赖技术的手术：LRP组（3441美元 ± 545美元）和CAP组（5702美元 ± 1606美元；P <0.0005）。包括病理评估成本在内的医院总成本差异，LRP组（10,047美元 ± 107美元，中位数9343美元）和CAP组（9195美元 ± 1511美元，中位数8796美元）低于RRP组（10,704美元 ± 3468美元，中位数9724美元）或RPP组（10,536美元 ± 3088美元，中位数9251美元），微创手术组与开放手术组之间存在显著差异（P <0.05）。
在我们的研究中，尽管与传统手术前列腺切除术（RRP或RPP）和LRP相比，CAP的手术费用相对增加，但总体直接成本被显著降低的非手术医院成本所抵消。与CAP相关的成本优势包括住院时间较短、无需病理成本以及无需输血。
