European Urology

Abstract

Background

Demand and utilization of minimally invasive approaches to radical prostatectomy have increased in recent years, but comparative studies on cost are lacking.

Objective

To compare costs associated with robotic-assisted laparoscopic radical prostatectomy (RALP), laparoscopic radical prostatectomy (LRP), and open retropubic radical prostatectomy (RRP).

Design, setting, and participants

The study included 643 consecutive patients who underwent radical prostatectomy (262 RALP, 220 LRP, and 161 RRP) between September 2003 and April 2008.

Measurements

Direct and component costs were compared. Costs were adjusted for changes over the time of the study.

Results and limitations

Disease characteristics (body mass index, preoperative prostate-specific antigen, prostate size, and Gleason sum score 8–10) were similar in the three groups. Nerve sparing was performed in 85% of RALP procedures, 96% of LRP procedures, and 90% of RRP procedures (p < 0.001). Lymphadenectomy was more commonly performed in RRP (100%) compared to LRP (22%) and RALP (11%) (p < 0.001). Mean length of hospital stay was higher for RRP than for LRP and RALP. The median direct cost was higher for RALP compared to LRP or RRP (RALP: $6752 [interquartile range (IQR): $6283–7369]; LRP: $5687 [IQR: $4941–5905]; RRP: $4437 [IQR: $3989–5141]; p < 0.001). The main difference was in surgical supply cost (RALP: $2015; LRP: $725; RRP: $185) and operating room (OR) cost (RALP: $2798; LRP: $2453; RRP: $1611; p < 0.001). When considering purchase and maintenance costs for the robot, the financial burden would increase by $2698 per patient, given an average of 126 cases per year.

Conclusions

RALP is associated with higher cost, predominantly due to increased surgical supply and OR costs. These costs may have a significant impact on overall cost of prostate cancer care.

Take Home Message

Robotic-assisted laparoscopic radical prostatectomy (RALP) is associated with higher cost when compared to laparoscopic and open retropubic radical prostatectomy. These costs significantly affect the costs of prostate cancer care. Evidence of functional and oncologic superiority will be needed to justify the high costs of RALP.