Skip to main content

Advertisement

SpringerLink
Log in

Cost Analysis of Open Radical Cystectomy Versus Robot-assisted Radical Cystectomy

  • New Imaging Techniques (A Atala, Section Editor)
  • Published:
Current Urology Reports Aims and scope Submit manuscript

Abstract

Bladder cancer is the fourth and ninth most common malignancy in males and females, respectively, in the U.S. and one of the most costly cancers to manage. With the current economic condition, physicians will need to become more aware of cost-effective therapies for the treatment of various malignancies. Robot-assisted radical cystectomy (RARC) is the latest minimally invasive surgical option for muscle-invasive bladder cancer. Current reports have shown less blood loss, a shorter hospital stay, and a lower morbidity with RARC, as compared with the traditional open radical cystectomy (ORC), although long-term oncologic results of RARC are still maturing. There are few studies that have assessed the cost outcomes of RARC as compared with ORC. Currently, ORC appears to offer a direct cost advantage due to the high purchase and maintenance cost of the robotic platform, although when the indirect costs of complications and extended hospital stay with ORC are considered, RARC may be less expensive than the traditional open procedure. In order to accurately evaluate the cost effectiveness of RARC versus ORC, prospective randomized trials between the two surgical techniques with long-term oncologic efficacy are needed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Sievert KD, Amend B, Nagele U, et al. Economic aspects of bladder cancer: what are the benefits and costs? World J Urol. 2009;27:295–300.

    Article  PubMed  CAS  Google Scholar 

  2. Stein JP, Lieskovsky G, Cote R, et al. Radical Cystectomy in the treatment of invasive bladder cancer: long-term results in 1,054 patients. J Clin Oncol. 2001;19:666–75.

    PubMed  CAS  Google Scholar 

  3. Shabsigh A, Korets R, Vora KC, et al. Defining early morbidity of radical cystectomy for patients with bladder cancer using a standardized reporting methodology. Eur Urol. 2009;55:164–76.

    Article  PubMed  Google Scholar 

  4. Pruthi RS, Nielsen ME, Nix J, et al. Robotic radical cystectomy for bladder cancer: surgical and pathological outcomes in 100 consecutive cases. J Urol. 2010;183:510–4.

    Article  PubMed  Google Scholar 

  5. Wang GJ, Barocas DA, Raman JD, et al. Robotic vs. open radical cystectomy: prospective comparison of perioperative outcomes and pathologic measures of early oncologic efficacy. BJU Int. 2007;101:89–93.

    PubMed  Google Scholar 

  6. Ng CK, Kauffman EC, Lee MM, et al. A comparison of postoperative complications in open vs. robotic cystectomy. Eur Urol. 2010;57:274–81.

    Article  PubMed  Google Scholar 

  7. Martin AD, Nunez RN, Pacelli A, et al. Robot-assisted radical cystectomy: intermediate survival results at a mean follow-up of 25 months. BJU Int. 2009;105:1706–9.

    Article  PubMed  Google Scholar 

  8. Mmeje CO, Nunez-Nateras, R, Nielsen ME, et al. Oncologic Outcomes for lymph node-positive urothelial carcinoma patients treated with robot assisted radical cytectomy: with mean follow-up of 3.5 years. Urol Oncol. 2012; Epub

  9. Russell LB, Gold MR, Siegel JE, et al. The role of cost-effectiveness analysis in health and medicine. JAMA. 1996;276:1172–7.

    Article  PubMed  CAS  Google Scholar 

  10. • Weinstein MC, Siegel JE, Gold MR, et al. Recommendations of the panel on cost-effectiveness in health and medicine. JAMA. 1996;276:1253–8. Recommendations on effective performance of cost-effective analysis.

    Article  PubMed  CAS  Google Scholar 

  11. • Detsky AS, Naglie IG. A clinician's guide to cost-effectiveness analysis. Ann Intern Med. 1990;113:147–54. Great overview of cost-effective analysis.

    PubMed  CAS  Google Scholar 

  12. Eisenberg JM. A guide to the economic analysis of clinical practices. JAMA. 1989;262(20):2879–86.

    Article  PubMed  CAS  Google Scholar 

  13. •• Smith A, Kurpad R, Lal A, et al. Cost analysis of robotic versus open radical cystectomy for bladder cancer. J Urol. 2010;183:505–9. First cost-analysis between open radical cystectomy and robot assisted radical cystectomy.

    Article  PubMed  Google Scholar 

  14. •• Martin AD, Nunez RN, Castle EP. Robot-assisted radical cystectomy versus open radical cystectomy: a complete cost analysis. Urology. 2011;77:621–5. Cost-analysis between open radical cystectomy and robot assisted radical cystectomy; includes both direct cost and indirect cost of 30-day complications and hospital medications.

    Article  PubMed  Google Scholar 

  15. •• Lee R, Ng CK, Shariat SF, et al. The economics of robotic cystectomy: cost comparison of open versus robotic. BJU Int. 2011;108:1886–92. Largest cost comparison between open radical cystectomy and robot assisted radical cystectomy. Patients were also stratified by form of urinary diversion.

    Article  PubMed  Google Scholar 

  16. • Yu H, Hevelone ND, Lipsitz SR, et al. Comparative analysis of outcomes and cost following open radical cystectomy versus robot assisted laparoscopic radical cystectomy: results from the US Nationwide Inpatient Sample. Eur Urol. 2012;61:1239–44. Population based comparison of outcomes between open radical cystectomy and robot assisted radical cystectomy, which also includes comparison of cost.

    Article  PubMed  Google Scholar 

  17. Pruthi RS, Wallen EM. Robotic-assisted laparoscopic radical cystoprostatectomy. Eur Urol. 2008;53:310–22.

    Article  PubMed  Google Scholar 

  18. Lotan Y, Cadeddu JA, Gettman MT. The new economics of radical prostatectomy: cost comparison of open, laparoscopic and robot assisted techniques. J Urol. 2004;172:1431–5.

    Article  PubMed  Google Scholar 

  19. Scales Jr CD, Jones PJ, Eisenstein EL, et al. Local cost structures and the economics of robot assisted radical prostatectomy. J Urol. 2005;174:2323–9.

    Article  PubMed  Google Scholar 

  20. Haber GP, Crouzet S, Gill IS, et al. Laparoscopic and robotic assisted radical cystectomy for bladder cancer: a critical analysis. Eur Urol. 2008;54:54–64.

    Article  PubMed  Google Scholar 

  21. Pruthi RS, Wallen EM. Robotic assisted laparoscopic radical cystoprostatectomy: operative and pathological outcomes. J Urol. 2007;178:814–8.

    Article  PubMed  Google Scholar 

  22. Hemal AK, Kolla SB, Wadhwa P. First case series of robotic radical cystoprostatectomy, bilateral pelvic lymphadenectomy and urinary diversion with da Vinci-S system. J Robotic Surg. 2008;2:35–40.

    Article  Google Scholar 

  23. Guru KA, Kim HL, Piacente PM, et al. Robot-assisted radical cystectomy and pelvic lymph node dissection: initial experience at Roswell Park Cancer Institute. Urology. 2007;69:469–74.

    Article  PubMed  Google Scholar 

  24. Pruthi RS, Stefaniak H, Hubbard JS, et al. Robotic assisted anterior exenteration for bladder cancer in female patient. J Endourol. 2008;22:2397–402.

    Article  PubMed  Google Scholar 

  25. Murphy DG, Challacombe BJ, Elhage O, et al. Robotic-assisted laparoscopic radical cytectomy with extracorporeal urinary diversion: initial experience. Eur Urol. 2008;54:570–80.

    Article  PubMed  Google Scholar 

  26. Abraham JB, Young JL, Box GN, et al. Comparative analysis of laparoscopic and robot-assisted radical cystectomy with ileal conduit urinary diversion. J Endourol. 2007;21:1473–80.

    Article  PubMed  Google Scholar 

  27. Novara G, De Marco V, Aragona M, et al. Complications and mortality after radical cystectomy for bladder transitional cell cancer. J Urol. 2009;182:914–21.

    Article  PubMed  Google Scholar 

  28. Monoharan M, Ayyathurai R, Soloway MS. Radical cystectomy for urothelial carcinoma of the bladder: an analysis of perioperative and survival outcome. BJU Int. 2009;104:1227–32.

    Article  Google Scholar 

  29. Konety BR, Allareddy V. Influence of post-cystectomy complications on cost and subsequent outcome. J Urol. 2007;177:280–7.

    Article  PubMed  Google Scholar 

  30. Chang SS, Baumgartner RG, Wells N, et al. Causes of increased hospital stay after radical cystectomy in a clinical pathway setting. J Urol. 2002;167:208–11.

    Article  PubMed  Google Scholar 

  31. Barbieri CE, Lee B, Cookson MS, et al. Association of procedure volume with radical cystectomy outcomes in a nationwide database. J Urol. 2007;178:1418–22.

    Article  PubMed  Google Scholar 

  32. Gold MR, Siegel JE, Russell LB, et al. Cost-effectiveness in health and medicine. Oxford University Press. 1996

Download references

Disclosure

C. O. Mmeje, A. D. Martin, R. Nunez-Nareras, and A. S. Parker reported no potential conflicts of interest relevant to this article; D. D. Thiel reported a consultancy with Myriad Genetics; and E. P. Castle reported no potential conflicts of interest relevant to this article.

Author information

Authors and Affiliations

  1. Urology Department, Mayo Clinic, Phoenix, AZ, USA

    Chinedu O. Mmeje, Aaron D. Martin, Rafael Nunez-Nateras & Erik P. Castle

  2. Department of Health Science Research, Mayo Clinic, Jacksonville, FL, USA

    Alexander S. Parker

  3. Urology Department, Mayo Clinic, Jacksonville, FL, USA

    David D. Thiel

Authors
  1. Chinedu O. Mmeje
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Aaron D. Martin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rafael Nunez-Nateras
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Alexander S. Parker
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. David D. Thiel
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Erik P. Castle
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Chinedu O. Mmeje.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mmeje, C.O., Martin, A.D., Nunez-Nateras, R. et al. Cost Analysis of Open Radical Cystectomy Versus Robot-assisted Radical Cystectomy. Curr Urol Rep 14, 26–31 (2013). https://doi.org/10.1007/s11934-012-0292-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11934-012-0292-7

Keywords

Search

Navigation