Robot-assisted laparoscopic prostatectomy: a costs and break-even point analysis for decision-making in a university hospital and a regional healthcare system in Northern Italy

Q3 Nursing
E. Fabbro, S. Crivellaro, C. D. Fratte, L. Vetrugno, G. Adani, B. Saule, Daniela Drigo, Giulia Zumerle, C. Favaretti, G. Guarrera
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Abstract

  BACKGROUND: Robotic Assisted Radical Prostatectomy (RALP) is one of the most expensive urological innovations. Prices of the “Da Vinci System” range from € 761.105 to € 1.902.762 for each unit, without taking into account the cost of maintenance and the use of additional devices. We evaluated outcomes, and costs retrospectively, comparing RALP to open retro-pubic radical prostatectomy (RRP) performed in our hospital between December 2009 and December 2010. METHODS: We compared 53 RALP, and 50 RRP in terms of costs, and clinical outcomes. We also implemented a Break Even Analysis in order to evaluate if the public reimbursement covered the total cost of RALP. RESULTS: According to our analysis, RALP showed lower hospitalization (p < 0,0001), higher early continence rate  (p < 0,0001), better potency rate in nerve sparing procedures  (p < 0,0142), and required no transfusions. Excluding the cost of purchasing and maintenance, single case costs were € 6.046,08 for RALP and € 4.834,11 for RRP, respectively. Considering the affordability of the technology, the point where the total revenue is sufficient to cover the total costs is an average of 60 cases performed per year, only in presence of additional reimbursement. CONCLUSIONS: Although our clinical analysis shows better results in favour of RALP, the economical analysis shows that RALP's costs are consistently higher than RRP. Considering also the purchasing costs, we demonstrate that the health gain of the technology does not necessarily offset the higher costs, even in a large, university hospital (1.000 beds).
机器人辅助腹腔镜前列腺切除术:意大利北部大学医院和地区医疗保健系统决策的成本和盈亏平衡点分析
背景:机器人辅助根治性前列腺切除术(RALP)是最昂贵的泌尿外科创新之一。“达芬奇系统”的价格从每台761.105欧元到1.902.762欧元不等,不考虑维护和使用额外设备的成本。我们回顾性评估了结果和成本,比较了2009年12月至2010年12月在我院进行的RALP和开放性后耻骨根治性前列腺切除术(RRP)。方法:我们比较了53个RALP和50个RRP的成本和临床结果。我们还实施了盈亏平衡分析,以评估公共报销是否覆盖了RALP的总成本。结果:根据我们的分析,RALP的住院率较低(p < 0.0001),早期失禁率较高(p < 0.0001),神经保留手术的效力率较高(p < 0.0142),并且无需输血。不包括采购和维护成本,RALP和RRP的单例成本分别为6.046万欧元和4.834万欧元。考虑到技术的可负担性,总收入足以支付总费用的点是平均每年执行60例,只有在有额外偿还的情况下。结论:尽管我们的临床分析显示RALP的效果更好,但经济分析显示RALP的成本始终高于RRP。考虑到购买成本,我们证明,即使在大型大学医院(1000张床位),该技术的健康收益也不一定抵消更高的成本。
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来源期刊
Epidemiology Biostatistics and Public Health
Epidemiology Biostatistics and Public Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-
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期刊介绍: Epidemiology, Biostatistics, and Public Health (EBPH) is a multidisciplinary journal that has two broad aims: -To support the international public health community with publications on health service research, health care management, health policy, and health economics. -To strengthen the evidences on effective preventive interventions. -To advance public health methods, including biostatistics and epidemiology. EBPH welcomes submissions on all public health issues (including topics like eHealth, big data, personalized prevention, epidemiology and risk factors of chronic and infectious diseases); on basic and applied research in epidemiology; and in biostatistics methodology. Primary studies, systematic reviews, and meta-analyses are all welcome, as are research protocols for observational and experimental studies. EBPH aims to be a cross-discipline, international forum for scientific integration and evidence-based policymaking, combining the methodological aspects of epidemiology, biostatistics, and public health research with their practical applications.
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