Division of Urologic Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
J Urol. 2010 Feb;183(2):505-9. doi: 10.1016/j.juro.2009.09.081. Epub 2009 Dec 14.
Recently robotic approaches to cystectomy have been reported, and while clinical and oncological efficacy continues to be evaluated, potential financial costs have not been clearly evaluated. In this study we present a financial analysis using current cost structures and clinical outcomes for robotic and open cystectomy for bladder cancer.
The financial costs of robotic and open radical cystectomy were categorized into operating room and hospital components, and further divided into fixed and variable costs for each. Fixed operating room costs for open cases involved base cost as well as disposable equipment costs while robotic fixed costs included the amortized machine cost as well as equipment and maintenance. Variable operating room costs were directly related to length of surgery. Variable hospital costs were directly related to transfusion requirement and length of stay. The means of the prior 20 cases of robotic and open cystectomy were used to perform a comparative cost analysis.
Mean fixed operating room costs for robotic cases were $1,634 higher than for open cases. Operating room variable costs were also higher by a difference of $570, directly related to increased operating room time. Hospital costs were nearly identical for the fixed component while variable costs were $564 higher for the open approach secondary to higher transfusion costs and longer mean length of stay. Based on these findings robotic cystectomy is associated with an overall higher financial cost of $1,640 (robotic $16,248 vs open $14,608). Cost calculators were constructed based on these fixed and variable costs for each surgical approach to demonstrate the expected total costs based on varying operating room time and length of stay.
Robotic assisted laparoscopic radical cystectomy is associated with a higher financial cost (+$1,640) than the open approach in the perioperative setting. However, this analysis is limited by its single institution design and a multicenter followup study is required to provide a more comprehensive analysis.
最近已经报道了机器人辅助膀胱切除术的方法，虽然临床和肿瘤学疗效仍在评估中，但潜在的财务成本尚未明确评估。在这项研究中，我们使用当前的成本结构和机器人辅助与开放性膀胱癌根治术的临床结果进行了财务分析。
机器人辅助和开放性根治性膀胱切除术的财务成本分为手术室和医院两个部分，并进一步分为每个部分的固定成本和可变成本。开放性病例的固定手术室成本包括基本成本和一次性设备成本，而机器人的固定成本包括摊销机器成本以及设备和维护成本。可变手术室成本与手术时间直接相关。可变医院成本与输血需求和住院时间直接相关。使用前 20 例机器人和开放性膀胱切除术的平均值进行了成本比较分析。
机器人病例的固定手术室成本平均比开放性病例高 1634 美元。手术室可变成本也高了 570 美元，这与手术时间的增加直接相关。医院固定部分的成本几乎相同，而开放性方法的可变成本高了 564 美元，这是由于输血成本较高和平均住院时间较长所致。基于这些发现，机器人膀胱切除术与整体更高的财务成本相关，高出 1640 美元（机器人 16248 美元与开放性 14608 美元）。根据这些固定和可变成本，为每种手术方法构建了成本计算器，以根据不同的手术室时间和住院时间演示预期的总成本。
在围手术期，与开放性方法相比，机器人辅助腹腔镜根治性膀胱切除术的财务成本更高（+1640 美元）。然而，这种分析受到其单中心设计的限制，需要进行多中心随访研究以提供更全面的分析。
