Department of Urology, Hôpital Erasme, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium.
Department of Urology, Institut Jules Bordet, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium.
Eur J Surg Oncol. 2023 Aug;49(8):1511-1518. doi: 10.1016/j.ejso.2022.07.023. Epub 2022 Aug 11.
Robotic-assisted radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD) is surging worldwide. Aim of the study was to perform a multicentric cost-analysis of RARC by comparing the gross cost of the intervention across hospitals in four different European countries.
Patients who underwent RARC + ICUD were recruited from eleven European centers in four European countries (Belgium, France, Netherlands, and UK) between 2015 and 2020. Costs were divided into six parts: cost for hospital stay, cost for ICU stay, cost for surgical theater occupation, cost for transfusion, cost for robotic instruments, and cost for stapling instruments. These costs were individually assessed for each patient.
A total of 490 patients were included. Median operative time was 300(270-360) minutes and median hospital length-of-stay was 11(8-15) days. The average total cost of RARC was 14.794€ (95%CI 14.300-15.200€). A significant difference was found for the total cost, as well as the various subcosts abovementioned, between the four included countries. Different sets and types of robotic instruments were used by each center, leading to a difference in cost of robotic instrumentation. Nearly 84% of costs of RARC were due to hospital stay (42%), ICU stay (3%) and operative time (39%), while 16% of costs were due to robotic (8%) and stapling (8%) instruments.
Costs and subcosts of RARC + ICUD vary significantly across European countries and are mainly dependent of hospital length-of-stay and operative time rather than robotic instrumentation. Decreasing length-of-stay and reducing operative time could help to decrease the cost of RARC and make it more widely accessible.
机器人辅助根治性膀胱切除术（RARC）联合体内尿路改道（ICUD）在全球范围内迅速发展。本研究旨在通过比较四个不同欧洲国家 11 个欧洲中心的干预总费用，对 RARC 进行多中心成本分析。
2015 年至 2020 年间，从四个欧洲国家（比利时、法国、荷兰和英国）的 11 个欧洲中心招募接受 RARC+ICUD 的患者。将成本分为六部分：住院费用、ICU 住院费用、手术室占用费用、输血费用、机器人器械费用和吻合器器械费用。分别评估每位患者的这些费用。
共纳入 490 例患者。中位手术时间为 300（270-360）分钟，中位住院时间为 11（8-15）天。RARC 的平均总成本为 14794 欧元（95%CI 14300-15200 欧元）。四个纳入国家之间的总费用以及上述各项子费用存在显著差异。每个中心使用的机器人器械种类和数量不同，导致机器人器械成本存在差异。RARC 近 84%的成本来自住院费用（42%）、ICU 住院费用（3%）和手术时间（39%），而 16%的成本来自机器人（8%）和吻合器（8%）器械。
RARC+ICUD 的成本和子成本在欧洲国家之间存在显著差异，主要取决于住院时间和手术时间，而不是机器人器械。缩短住院时间和减少手术时间可能有助于降低 RARC 的成本，使其更广泛地普及。
