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Health care cost consequences of using robot technology for hysterectomy: a register-based study of consecutive patients during 2006–2013

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Abstract

The objective of this study is to examine the costs attributable to robotic-assisted laparoscopic hysterectomy from a broad healthcare sector perspective in a register-based longitudinal study. The population in this study were 7670 consecutive women undergoing hysterectomy between January 2006 and August 2013 in public hospitals in Denmark. The interventions in the study were total and radical hysterectomy performed robotic-assisted laparoscopic hysterectomy (RALH), total laparoscopic hysterectomy (TLH), or open abdominal hysterectomy (OAH). Service use in the healthcare sector was evaluated 1 year before to 1 year after the surgery. Tariffs of the activity-based remuneration system and the diagnosis-related grouping case-mix system were used for valuation of primary and secondary care, respectively. Costs attributable to RALH were estimated using a difference-in-difference analytical approach and adjusted using multivariate linear regression. The main outcome measure was costs attributable to OAH, TLH, and RALH. For benign conditions RALH generated cost savings of € 2460 (95% CI 845; 4075) per patient compared to OAH and non-significant cost savings of € 1045 (95% CI −200; 2291) when compared with TLH. In cancer patients RALH generated cost savings of 3445 (95% CI 415; 6474) per patient when compared to OAH and increased costs of € 3345 (95% CI 2348; 4342) when compared to TLH. In cancer patients undergoing radical hysterectomy, RALH generated non-significant extra costs compared to OAH. Cost consequences were primarily due to differences in the use of inpatient service. There is a cost argument for using robot technology in patients with benign disease. In patients with malignant disease, the cost argument is dependent on comparator.

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Acknowledgements

We would like to thank Line Stjernholm Tipsmark, DEFACTUM, Central Denmark Region, Denmark, for her valuable contribution on requisition of data and provisional analyses.

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Authors and Affiliations

  1. Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus, Denmark

    Karin Rosenkilde Laursen, Vibe Bolvig Hyldgård & Rikke Søgaard

  2. Health Economics, DEFACTUM, Central Denmark Region, Olof Palmes Allé 15, 8200, Aarhus N, Denmark

    Vibe Bolvig Hyldgård

  3. Department of Gynecology and Obstetrics, Odense University Hospital, Søndre Blvd. 29, 5000, Odense C, Denmark

    Pernille Tine Jensen

  4. Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark

    Rikke Søgaard

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  1. Karin Rosenkilde Laursen
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Corresponding author

Correspondence to Vibe Bolvig Hyldgård.

Ethics declarations

This study has been conducted in accordance with The Person Data Act, and approval from The Danish Data Protection Agency has been obtained (journal number 2007-58-0010).

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All authors declare that they have no conflict of interest.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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None declared.

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Laursen, K.R., Hyldgård, V.B., Jensen, P.T. et al. Health care cost consequences of using robot technology for hysterectomy: a register-based study of consecutive patients during 2006–2013. J Robotic Surg 12, 283–294 (2018). https://doi.org/10.1007/s11701-017-0725-x

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  • DOI: https://doi.org/10.1007/s11701-017-0725-x

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