Health care cost consequences of using robot technology for hysterectomy: a register-based study of consecutive patients during 2006–2013
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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.
KeywordsCost analysis Economics Gynaecologic Hysterectomy Robot-assisted surgery
We would like to thank Line Stjernholm Tipsmark, DEFACTUM, Central Denmark Region, Denmark, for her valuable contribution on requisition of data and provisional analyses.
Compliance with ethical standards
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).
Conflict of interest
All authors declare that they have no conflict of interest.
This article does not contain any studies with human participants or animals performed by any of the authors.
- 5.Liu H, Lu D, Wang L, Shi G, Song H, Clarke J (2012) Robotic surgery for benign gynaecological disease (review). Cochrane Collab 2:1–20Google Scholar
- 18.Aarts J, Nieboer T, Johnson N, Tavender E, Garry R, Mol B. Surgical approach to hysterectomy for benign gynaecological disease. Cochrane Database Syst Rev. 2015;12(8):13–37Google Scholar
- 27.Shi G, Lu D, Liu Z, Liu D, Zhou X. Robotic assisted surgery for gynaecological cancer (review). Cochrane Collab. 2014;(1):7–9. doi: 10.1002/14651858.CD008640.pub2
- 29.CFK Folkesundhed & Kvalitetsudvikling. Health Technology assessment of robot-assisted surgery [Medicinsk teknologivurdering af robotassisteret kirurgi]. 2015Google Scholar
- 33.National Cancer Institute. Cancer Staging [Internet]. http://www.cancer.gov/cancertopics/factsheet/detection/staging. Cited 8 Nov 2015
- 41.Kilic GS, Moore G, Elbatanony A, Radecki C, Phelps JY, Borahay MA (2011) Comparison of perioperative outcomes of total laparoscopic and robotically assisted hysterectomy for benign pathology during introduction of a robotic program. Obstet Gynecol Int 2011:683703CrossRefPubMedPubMedCentralGoogle Scholar