Urologic Unit, ASST Santi Paolo and Carlo, Milan, Italy.
Budgeting and Reporting's Office, ASST Santi Paolo and Carlo, Milan, Italy.
J Robot Surg. 2024 Jun 13;18(1):251. doi: 10.1007/s11701-024-01930-w.
Robotic surgery with Da Vinci has revolutionized the treatment of several diseases, including prostate cancer; nevertheless, costs remain the major drawback. Recently, new robotic platforms entered the market aiming to reduce costs and improve the access to robotic surgery. The aim of the study is to compare direct cost for initial hospital stay of radical prostatectomy performed with two different robotic systems, the Da Vinci and the new Hugo RAS system. This is a projection study that applies cost of robotic surgery, derived from a local tender, to the clinical course of robotic radical prostatectomy (RALP) performed with Da Vinci and Hugo RAS. The study was performed in a public referral center for robotic surgery equipped with both systems. The cost of robotic surgery from a local tender were considered and included rent, annual maintenance, and a per-procedure fee covering the setup of four robotic instruments. Those costs were applied to patients who underwent RALP with both systems since November 2022. The primary endpoint is to evaluate direct costs of initial hospital stay for Da Vinci and Hugo RAS, by considering equipment costs (as derived from the tender), and costs of theater and of hospitalization. The direct per-procedure cost is €2,246.31 for a Da Vinci procedure and €1995 for a Hugo RALP. In the local setting, Hugo RAS provides 11% of cost saving for RALP. By applying this per-procedure cost to our clinical data, the expenditure for the entire index hospitalization is € 6.7755,1 for Da Vinci and € 6.637,15 for Hugo RALP. The new Hugo RAS system is willing to reduce direct expenditures of robotic surgery for RALP; furthermore, it provides similar peri-operative outcomes compared to the Da Vinci. However, other drivers of costs should be taken into account, such as the duration of OR use-that is more than just console time and may depend on the facility's background and organization. Further variations in direct costs of robotic systems are related to caseload, local agreements and negotiations. Thus, cost comparison of new robotic platform still remains an ongoing issue.
达芬奇机器人手术彻底改变了多种疾病的治疗方式，包括前列腺癌；然而，成本仍然是主要的障碍。最近，新的机器人平台进入市场，旨在降低成本并提高机器人手术的可及性。本研究旨在比较两种不同的机器人系统，达芬奇和新的 Hugo RAS 系统，进行根治性前列腺切除术的直接住院费用。这是一项预测研究，将从当地招标中获得的机器人手术成本应用于达芬奇和 Hugo RAS 进行的机器人根治性前列腺切除术（RALP）的临床过程。该研究在一家配备这两种系统的机器人手术转诊中心进行。考虑了从当地招标中获得的机器人手术成本，并包括租赁费、年度维护费和涵盖四个机器人仪器设置的每例手术费用。自 2022 年 11 月以来，这些成本被应用于两种系统进行 RALP 的患者。主要终点是通过考虑设备成本（来自招标）和手术室及住院费用，评估达芬奇和 Hugo RAS 的初始住院直接费用。达芬奇手术的每例手术直接成本为 2246.31 欧元，Hugo RALP 为 1995 欧元。在当地环境下，Hugo RAS 为 RALP 节省 11%的成本。将此每例手术成本应用于我们的临床数据，达芬奇的整个索引住院费用为 67755.1 欧元，而 Hugo RALP 为 66371.55 欧元。新的 Hugo RAS 系统有望降低 RALP 的机器人手术直接支出；此外，与达芬奇相比，它提供了相似的围手术期结果。然而，还应考虑其他成本驱动因素，例如手术室使用时间——不仅仅是控制台时间，可能取决于医院的背景和组织。机器人系统的直接成本的进一步变化与病例量、当地协议和谈判有关。因此，新机器人平台的成本比较仍然是一个正在进行的问题。
