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Cost comparison of open approach, transoral laser microsurgery and transoral robotic surgery for partial and total laryngectomies

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Abstract

Activity-based costing is used to give a better insight into the actual cost structure of open, transoral laser microsurgery (TLM) and transoral robotic surgery (TORS) supraglottic and total laryngectomies. Cost data were obtained from hospital administration, personnel and vendor structured interviews. A process map identified 17 activities, to which the detailed cost data are related. One-way sensitivity analyses on the patient throughput, the cost of the equipment or operative times were performed. The total cost for supraglottic open (135–203 min), TLM (110–210 min) and TORS (35–130 min) approaches were 3,349 € (3,193–3,499 €), 3,461 € (3,207–3,664 €) and 5,650 € (4,297–5,974 €), respectively. For total laryngectomy, the overall cost were 3,581 € (3,215–3,846 €) for open and 6,767 € (6,418–7,389 €) for TORS. TORS cost is mostly influenced by equipment (54 %) where the other procedures are predominantly determined by personnel cost (about 45 %). Even when we doubled the yearly case-load, used the shortest operative times or a calculation without robot equipment costs we did not reach cost equivalence. TORS is more expensive than standard approaches and mainly influenced by purchase and maintenance costs and the use of proprietary instruments. Further trials on long-term outcomes and costs following TORS are needed to evaluate its cost-effectiveness.

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Conflict of interest

Hereby, all authors declare that we do not have any conflicts of interest in the manuscript, including financial, consultant, institutional and other relationships that might lead to bias or a conflict of interest.

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Authors and Affiliations

  1. Business Administration Department, University of Namur, Namur, Belgium

    Manon Dombrée & Annick Castiaux

  2. Namur Research Institute for Life Sciences, University of Namur, Namur, Belgium

    Georges Lawson, Pascal Janne, Annick Castiaux & Bruno Krug

  3. Department of Head and Neck Surgery, CHU UCL Mont-Godinne–Dinant, Yvoir, Belgium

    Georges Lawson

  4. Administration, CHU UCL Mont-Godinne–Dinant, Yvoir, Belgium

    Pascal Janne & Bruno Krug

  5. Nuclear Medicine Division, CHU UCL Mont-Godinne–Dinant, Université Catholique de Louvain, 1 Dr Therasse, 5530, Yvoir, Belgium

    Bruno Krug

  6. Institute of Health and Society, Université Catholique de Louvain, Yvoir, Belgium

    Ralph Crott & Bruno Krug

Authors
  1. Manon Dombrée
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  2. Ralph Crott
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  3. Georges Lawson
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  4. Pascal Janne
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  5. Annick Castiaux
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  6. Bruno Krug
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Correspondence to Bruno Krug.

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Dombrée, M., Crott, R., Lawson, G. et al. Cost comparison of open approach, transoral laser microsurgery and transoral robotic surgery for partial and total laryngectomies. Eur Arch Otorhinolaryngol 271, 2825–2834 (2014). https://doi.org/10.1007/s00405-014-3056-9

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  • DOI: https://doi.org/10.1007/s00405-014-3056-9

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