Department of Urology, Mannheim Medical Center, University of Heidelberg, Mannheim, Germany.
Department of Surgery - Durham VA Medical Center, and Departments of Surgery (Urology) and Pathology, Duke University School of Medicine, Durham, NC, USA.
Eur Urol. 2014 Feb;65(2):316-24. doi: 10.1016/j.eururo.2012.08.059. Epub 2012 Sep 5.
Robot-assisted laparoscopic radical prostatectomy (RALP) has been rapidly adopted as a new approach for radical prostatectomy (RP) in patients with prostate cancer (PCa). The use of new technology may increase costs for RP.
To summarize data on direct costs of various approaches to RP and to discuss the consequences of cost differences.
A systematic literature search was performed in March 2012 using the PubMed, Web of Science, and Cochrane Library databases. A complex search strategy was applied. Articles were selected according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. Articles reporting on direct costs of RP (open retropubic [RRP], radical perineal [RPP], laparoscopic [LRP], RALP) in men with clinically localized PCa were eligible for study inclusion.
Of 1218 articles initially screened by title, the multistep, systematic search identified 11 studies presenting direct costs of different approaches to RP. Of the 11 studies, 7 compared the costs of different RP approaches. Minimally invasive RP (MIRP) (ie, LRP or RALP) was more expensive than RRP in most studies, mainly due to increased surgical instrumentation costs. In the comparative studies, costs ranged from (in US dollars) $5058 to $11,806 for MIRP and from $4075 to $6296 for RRP, with RALP having the highest direct costs. In one study applying standardized, health economic-evaluation criteria, RALP was not found to be cost effective. Limitations of this review include significant differences in observational study designs and an absence of prospective comparative studies. Moreover, there are limited post-RP data on the costs of adjuvant treatments and other health care-related expenses after PCa surgery.
Few studies compared direct costs of different approaches to RP. The use of new technology, particularly RALP, results in added costs for the procedure. Cost effectiveness of new technologies should be assessed before widespread adoption. To date, in the lone study to evaluate this, RALP was not found to be cost effective from a health care, economic standpoint. However, longer follow-up of patients is required to better evaluate its impact on overall costs and quality of PCa care.
机器人辅助腹腔镜前列腺根治术（RALP）已迅速被采用为前列腺癌（PCa）患者前列腺根治术（RP）的新方法。新技术的使用可能会增加 RP 的成本。
总结各种 RP 方法的直接成本数据，并讨论成本差异的后果。
2012 年 3 月，使用 PubMed、Web of Science 和 Cochrane 图书馆数据库进行了系统文献检索。应用了复杂的搜索策略。根据系统评价和荟萃分析的首选报告项目标准，选择了报告 RP（开放式Retropubic [RRP]、根治性会阴 [RPP]、腹腔镜 [LRP]、RALP）直接成本的文章，纳入了研究范围。
通过标题初筛，共筛选出 1218 篇文章，通过多步骤系统检索，确定了 11 篇研究报告了不同 RP 方法的直接成本。在 11 项研究中，有 7 项研究比较了不同 RP 方法的成本。微创 RP（MIRP）（即 LRP 或 RALP）在大多数研究中比 RRP 更昂贵，主要是由于手术器械成本增加。在比较研究中，MIRP 的成本范围为（美元）5058 至 11806 美元，RRP 的成本范围为 4075 至 6296 美元，RALP 的直接成本最高。在一项应用标准化健康经济评估标准的研究中，RALP 被认为不具有成本效益。本综述的局限性包括观察性研究设计存在显著差异，缺乏前瞻性比较研究。此外，关于 PCa 手术后辅助治疗和其他与健康相关的费用的 RP 后数据有限。
很少有研究比较不同 RP 方法的直接成本。新技术的使用，特别是 RALP，会增加手术的成本。在广泛采用新技术之前，应评估其成本效益。迄今为止，在唯一一项评估该技术的研究中，RALP 从医疗保健的经济角度来看并不具有成本效益。然而，需要对患者进行更长时间的随访，以更好地评估其对整体成本和 PCa 护理质量的影响。
