Bansal Sukhchain S, Dogra Tara, Smith Peter W, Amran Maisarah, Auluck Ishna, Bhambra Maninder, Sura Manraj S, Rowe Edward, Koupparis Anthony
Imperial College London, London, UK.
University of Birmingham, Birmingham, UK.
BJU Int. 2018 Mar;121(3):437-444. doi: 10.1111/bju.14044. Epub 2017 Nov 1.
To perform a cost analysis comparing the cost of robot-assisted radical cystectomy (RARC) with open RC (ORC) in a UK tertiary referral centre and to identify the key cost drivers.
Data on hospital length of stay (LOS), operative time (OT), transfusion rate, and volume and complication rate were obtained from a prospectively updated institutional database for patients undergoing RARC or ORC. A cost decision tree model was created. Sensitivity analysis was performed to find key drivers of overall cost and to find breakeven points with ORC. Monte Carlo analysis was performed to quantify the variability in the dataset.
One RARC procedure costs £12 449.87, or £12 106.12 if the robot was donated via charitable funds. In comparison, one ORC procedure costs £10 474.54. RARC is 18.9% more expensive than ORC. The key cost drivers were OT, LOS, and the number of cases performed per annum.
High ongoing equipment costs remain a large barrier to the cost of RARC falling. However, minimal improvements in patient quality of life would be required to offset this difference.
在英国一家三级转诊中心进行成本分析，比较机器人辅助根治性膀胱切除术（RARC）与开放性根治性膀胱切除术（ORC）的成本，并确定关键成本驱动因素。
从一个前瞻性更新的机构数据库中获取接受RARC或ORC治疗患者的住院时间（LOS）、手术时间（OT）、输血率、出血量及并发症发生率等数据。创建了一个成本决策树模型。进行敏感性分析以找出总成本的关键驱动因素，并找出与ORC的盈亏平衡点。进行蒙特卡洛分析以量化数据集中的变异性。
一台RARC手术成本为12449.87英镑，若机器人通过慈善基金捐赠则为12106.12英镑。相比之下，一台ORC手术成本为10474.54英镑。RARC比ORC贵18.9%。关键成本驱动因素是手术时间、住院时间和每年进行的病例数。
持续高昂的设备成本仍然是RARC成本下降的一大障碍。然而，只需在患者生活质量上有极小的改善就能抵消这一差异。
