Laparoscopic Prostatectomy

Radical prostatectomy is the most common therapy for patients with prostate cancer and accounts for approximately half of the $1.7 billion cost of prostate cancer treatment (30). In evaluating the cost of radical retropubic prostatectomy as compared to laparo-scopic and robot-assisted prostatectomy, we found that radical retropubic prostatectomy was the least expensive approach with a cost advantage of $487 and $1726 over laparoscopic radical prostatectomy and robot-assisted prostatectomy, respectively (Table 2) (7). Even if the initial cost of purchasing a robot is excluded, the cost difference between radical retropubic prostatectomy and robot-assisted prostatectomy is $1155.

TABLE2 ■ Individual and Overall Costs for Radial Retropubic Prostatectomy, Laparoscopic Radical Prostatectomy, and Robot-Assisted Prostatectomy

Cost center

RRP ($)

LRP ($)

RAPa($)

Overall cost

5554

6041

7280

Operating room cost

2428

2876

2204

Equipment

75

533

1705

Surgeon professional fee

1594

1688

1688

Hospital room and board

988

514

474

Intravenous fluids/meds

150

78

72

Robot cost/case (purchase + maintenance)

NA

NA

857

aRobot purchase cost included.

Abbreviations: RRR radical retropubic prostatectomy; LRR laparoscopic radical prostatectomy; RAR robot-assisted prostatectomy; NA, not applicable. Source: From Ref. 7.

1600.0

m 1200.0

□ Radical retropubic Prostatectomy ■ Robot-Assisted Prostatectomy

FIGURE3 ■ Two-way sensitivity analysis evaluating costs of robot purchase and RAP (robot-assisted prostatectomy) equipment (assuming $100,000 per year maintenance cost). Abbreviation: RAP, Robot-Assisted Prostatectomy. Source: From Ref. 7.

□ Radical retropubic Prostatectomy ■ Robot-Assisted Prostatectomy

FIGURE3 ■ Two-way sensitivity analysis evaluating costs of robot purchase and RAP (robot-assisted prostatectomy) equipment (assuming $100,000 per year maintenance cost). Abbreviation: RAP, Robot-Assisted Prostatectomy. Source: From Ref. 7.

LRP Length of stay (Days) □ Radical retropubic prostatectomy U Laparoscopic retropubic prostatectomy

FIGURE4 ■ Two-way sensitivity analysis evaluating laparoscopic radical prostatectomy length of stay and operating room time. Source: From Ref. 7.

This large difference in radical retropubic prostatectomy and robot-assisted prostatectomy costs resulted from a cost of $857 per case, to pay for purchase and maintenance of the robot, and the high cost of equipment of $1705. Even shorter operating room time (140 minutes vs. 160 minutes) and length of stay 1.2 days vs. 2.5 days) did not compensate for the added expenditure. At current costs for the robot (purchase, maintenance, and equipment) there is no individual decrease in length of stay or operating room time that would make robot-assisted prostatectomy cost-equivalent to radical retropubic prostatectomy. In order for robot-assisted prostatectomy to realistically become cost-equivalent or superior, there needs to be a decrease in both the purchase price of the robot and the cost of equipment per case (Fig. 3) (7).

Laparoscopic radical prostatectomy also costs more than radical retropubic prostatectomy primarily secondary to equipment costs ($533) as the shorter length of stay (1.3 days vs. 2.5 days) compensates for the longer operating room time (200 minutes vs. 160 minutes). However, decreases in both length of stay and operating room time for laparoscopic radical prostatectomy will allow cost equivalence with radical retropubic prostatectomy (Fig. 4). Similarly, small decreases in equipment costs in conjunction with shorter operating room times can make laparoscopic radical prostatectomy financially superior (Fig. 5). Thus, while radical retropubic prostatectomy is currently the least costly approach, laparoscopic radical prostatectomy is cost-competitive with radical retropubic prostatectomy, whereas robot-assisted prostatectomy will require a significant reduction in the cost of the device and maintenance fees to be financially justified.

FIGURE 5 ■ Two-way sensitivity analysis evaluating laparoscopic radical prostatectomy equipment costs and operating room time. Source: From Ref. 7.

0.0 200.0 400.0 600.0 800.0

LRP Equipment costs ($) □ Radical Retropubic Prostatectomy ■ Laparoscopic Retropubic Prostatectomy

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