Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9110, USA.
J Endourol. 2012 Aug;26(8):1044-8. doi: 10.1089/end.2012.0026. Epub 2012 May 23.
Laparoscopic repair of ureteropelvic junction obstruction is now the standard of care at many institutions. The objective of this study is to compare costs associated with robot-assisted pyeloplasty (RP) vs laparoscopic pyeloplasty (LP).
A decision analysis model was developed to compare costs of each procedure based on hospital-related cost centers. A literature search was performed to identify nonoverlapping studies with outcomes for RP and LP. Weighted means were calculated for operative time and length of stay. Cost data were obtained from our institution. One- and two-way sensitivity analyses were performed to evaluate the effect of changing variables on the cost-effectiveness of RP.
Eight studies were identified with 181 and 145 patients undergoing RP or LP, respectively. Operative times were 211 minutes for RP and 224 minutes for LP. Hospital stays were shorter for RP at 1.54 days compared with 1.98 days for LP. Mean direct costs were higher for RP at $10,635 vs $9,065 for LP. The largest difference was in fixed surgical supply costs per case at $1357 for RP and $406 for LP. One-way sensitivity analysis showed that RP would be cost effective if performed in less than 96 minutes. Even if RP was performed on an outpatient basis or more than 1000 cases/year, however, LP would still be cost superior. Two-way analyses showed areas where RP could be more cost-effective than LP.
RP is associated with higher cost compared with LP, predominately because of the cost of the robot and surgical supply costs. Decreasing operative time and equipment costs may result in RP being more cost-effective than LP. Shorter hospital stay alone, however, is insufficient to allow RP to be cost-effective. One would need to demonstrate tangible advantages to the robot to justify the added costs.
腹腔镜治疗肾盂输尿管连接部梗阻（UPJO）现已成为许多机构的标准治疗方法。本研究旨在比较机器人辅助肾盂成形术（RP）与腹腔镜肾盂成形术（LP）相关的成本。
我们建立了一个决策分析模型，以根据医院相关成本中心比较每种手术的成本。我们进行了文献检索，以确定具有 RP 和 LP 结果的非重叠研究。加权均值用于计算手术时间和住院时间。成本数据来自我们的机构。我们进行了单因素和双因素敏感性分析，以评估变量变化对 RP 成本效益的影响。
共确定了 8 项研究，其中分别有 181 例和 145 例患者接受了 RP 或 LP。RP 的手术时间为 211 分钟，LP 为 224 分钟。RP 的住院时间较短，为 1.54 天，而 LP 为 1.98 天。RP 的直接平均成本为 10635 美元，而 LP 为 9065 美元。最大的差异在于每例手术的固定手术供应成本，RP 为 1357 美元，LP 为 406 美元。单因素敏感性分析表明，如果手术时间少于 96 分钟，RP 将具有成本效益。然而，即使 RP 在门诊进行或每年进行超过 1000 例手术，LP 仍将具有成本优势。双因素分析表明，RP 可能比 LP 更具成本效益。
与 LP 相比，RP 相关的成本更高，主要是因为机器人和手术供应成本较高。如果能够降低手术时间和设备成本，RP 可能会比 LP 更具成本效益。但是，仅靠缩短住院时间不足以使 RP 具有成本效益。需要证明机器人具有明显优势才能证明增加的成本是合理的。
