Popularity of Robotic Radical Prostatectomy Comes with a High Price

An analysis using the IMS LifeLink Health Plan Claims Database has shown that patients who undergo minimally invasive robotic-assisted radical prostatectomy experience a shorter hospital length of stay and somewhat better postoperative outcomes than patients who undergo open radical prostatectomy, albeit with a higher price tag, according to a study that was published recently in Prostate Cancer and Prostatic Disease.1

Senior author Nilay Shah, PhD, Consultant, Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN, and colleagues from across the United States used the LifeLink database to select privately insured patients with prostate cancer who underwent open radical prostatectomy or minimally invasive radical prostatectomy in the United States between 2003 and 2010.

“The primary outcomes of this study were LOS [length of stay], perioperative complications, 90-day readmission rates, and total hospital reimbursement,” Dr Shah and colleagues wrote. “We defined perioperative complications similar to previous studies examining the comparative effectiveness of MIRP [minimally invasive robotic-­assisted radical prostatectomy] versus ORP [open radical prostatectomy].”

The LifeLink database included 8629 patients who underwent open radical prostatectomy in 2003-2010, and 8981 who underwent the minimally invasive radical prostatectomy during the same time period; a total of 4092 surgeons performed these procedures. The rate of minimally invasive radical prostatectomy quickly eclipsed that of open radical prostatectomy, with 1.0% of patients receiving minimally invasive radical prostatectomy in 2003 and 74% in 2010. The members of the 2 groups had similar average ages—approximately 58 years—and number of comorbidities.

The median length of stay was 1 day for patients in the minimally invasive radical prostatectomy group and 3 days for those in the open radical prostatectomy group (P <.0001). The rates of wound, vascular, and medical perioperative complications were statistically similar for patients in the 2 groups. There was, however, a significantly lower rate of respiratory complications for patients who underwent minimally invasive radical prostatectomy compared with those undergoing open radical prostatectomy, at 0.7% versus 1.1%, respectively (P = .005). There was also a lower rate of genitourinary complications, at 1.2% versus 1.7% (P = .007), respectively. As a result, the rate of overall complications was lower for patients who underwent minimally invasive radical prostatectomy: 2.1% versus 3.0% (P <.001), respectively.

The researchers’ analysis revealed a 24% lower adjusted risk of genitourinary complications (adjusted odds ratio [OR], 0.76; P <.001) for patients undergoing minimally invasive radical prostatectomy and an 18% lower adjusted risk of overall complications (adjusted OR, 0.82; P <.001). The 90-day readmission rates were similar for patients in both groups: 5.2% for patients in the minimally invasive radical prostatectomy group and 5.3% for those in the open radical prostatectomy group (P = .85).

Mean hospital reimbursement was significantly higher for the minimally invasive radical prostatectomy procedure, at $19,292 per procedure compared with $17,347 for the open radical prostatectomy procedure (P <.001). This translates into approximately $126.4 million in additional reimbursement provided to hospitals for performing robotic surgery from 2003 to 2010, the authors calculated.

Dr Shah said that more information is required for a formal cost-­effectiveness analysis.

“Specifically, we would have to survey patients at different time points after surgeries to be able to calculate QALYs [quality-adjusted life-years]. This data is not yet available, but would be an additional piece of information to further understand the impact of different types of surgeries,” he observed.

Reference

  1. Kim SP, Gross CP, Smaldone MC, et al. Perioperative outcomes and hospital reimbursement by type of radical prostatectomy: results from a privately insured patient population. Prost Cancer Prost Dis. 2015;18:13-17.

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