Economic evaluation of da Vinci-assisted robotic surgery: a systematic review
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Health technology assessment (HTA) is frequently used when a new and expensive technology is being introduced into clinical practice. This certainly is the case with the da Vinci surgical robot, with costs ranging from $1 to $2.5 million for each unit. This systematic review documents major variability in the reported cost evaluation studies of da Vinci robot-assisted operations compared with those performed by the direct manual laparoscopic approach.
Published studies in the English language related to the period 2000–2010 were searched using economic and clinical electronic databases.
All 11 reports included some form of cost analysis, which made it possible for the authors to extract information on certain specific economic outcomes: operating room time, hospital stay, and total costs. With the exception of two studies, the reported operating room time was higher with the robotic approach than with manual laparoscopic surgery, and the hospital stay was the same for the two techniques. Robotic surgery is significantly more expensive if the purchase and maintenance costs of the robot system are included in the total costs. Only 3 of the 11 publications included these costs.
The disadvantage of robotic surgery is its higher costs related to purchase and maintenance of technology and its longer operating room time. However, emerging evidence shows that operating room time decreases with experience using the robot. From the HTA viewpoint, the result of this review is that the jury still is out on the HTA of da Vinci-assisted robotic surgery.
Keywordsda Vinci Direct manual laparoscopic surgery Health economic evaluation
The authors thank the clinical units involved in the project. They also thank Professors Mario Morino and Fabrizio Rebecchi from Le Molinette University Hospital of Turin, Professor Lorenzo Spaggiari and Dr Domenico Galetta from European Oncology Institute of Milan, and Professor Alfredo Mussi, Dr Franca Melfi, Dr Federico Davini, Dr Vito Cela, and Dr Nicola Pluchino from the University Hospital of Pisa. The study was funded by a MIUR grant in the 2008 PRIN program: Health Technology Assessment of the da Vinci Master Slave Manipulator in Italy (CUP code J51J10000000001).
Giuseppe Turchetti, Ilaria Palla, Francesca Pierotti, and Alfred Cuschieri have no conflicts of interests or financial ties to disclose.
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