Department of Econometrics, Statistics and Applied Economics, Faculty of Economics and Business, Universitat de Barcelona, Avinguda Diagonal 690-696, 08034 Barcelona, Spain; Department of Health Policy, London School of Economics and Political Science, Houghton Street, WC2A 2AE London, UK; Center for Research in Health and Economics (CRES), Universitat Pompeu Fabra, Ramon Trias Fargas 25-27 08005 Barcelona, Spain.
Department of Health Policy, London School of Economics and Political Science, Houghton Street, WC2A 2AE London, UK.
Health Policy. 2022 Apr;126(4):325-336. doi: 10.1016/j.healthpol.2022.02.007. Epub 2022 Feb 27.
This paper examines the adoption and diffusion of medical technology as associated with the dramatic recent increase in the surgical use of robots. We consider specifically the sequential adoption and diffusion patterns of three interrelated surgical technologies within a single healthcare system (the English NHS): robotic, laparoscopic and open radical prostatectomy. Robotic and laparoscopic techniques are minimally invasive procedures with similar patient benefits, but the newer robotic technique requires a high initial investment cost to purchase the robot and carries high maintenance costs over time. Using data from a large UK administrative database, Hospital Episodes Statistics, for the period 2000-2018, we analyse 173 hospitals performing radical prostatectomy, the most prevalent and earliest surgical area of adoption of robotic surgery. Our empirical analysis first identifies substitution effects, with robotic surgery replacing the incumbent technology, including the recently diffused laparoscopic technology. We then quantify the spillover of robotic surgery as it diffuses to other surgical specialties. Finally, we perform time-to-event analysis at the hospital level to quantitatively examine the adoption. Results show that a higher number of urologists and a wealthier referral area favor robot adoption.
本文考察了医疗技术的采用和普及，这与机器人在外科手术中的近期广泛应用密切相关。我们特别关注了单一医疗体系（英国国家医疗服务体系）内三种相互关联的外科技术的顺序采用和扩散模式：机器人手术、腹腔镜手术和开放式根治性前列腺切除术。机器人和腹腔镜技术都是微创程序，具有相似的患者获益，但更新的机器人技术需要购买机器人的高额初始投资成本，并随着时间的推移产生高昂的维护成本。我们利用 2000 年至 2018 年期间来自英国大型行政数据库——医院入院统计的数据集，分析了 173 家开展根治性前列腺切除术的医院，这是机器人手术最早采用和最普遍的外科领域。我们的实证分析首先确定了机器人手术对现有技术（包括最近普及的腹腔镜技术）的替代效应。然后，我们量化了机器人手术在扩散到其他外科专业时的溢出效应。最后，我们在医院层面进行了事件时间分析，以定量考察采用情况。结果表明，泌尿科医生数量较多且转诊地区较富裕的医院更倾向于采用机器人技术。
