Health Care Costs and Utilization Associated With Open vs Robotic-Assisted Radical Prostatectomy

Study findings suggest that although total cumulative costs were similar between patients who underwent open vs robotic-assisted radical prostatectomy, lower postdischarge health care utilization after robotic-assisted prostatectomy may offset the higher costs during the index hospitalization (JAMA Netw Open. 2021;4[3]:e212265. doi:10.1001/jamanetworkopen.2021.2265).

“With the current patterns of adoption and use of robotic surgery and improvement in the overall survival of patients with prostate cancer, it is important to evaluate the immediate and long-term cost implications of treatments for patients with prostate cancer,” wrote Kennedy E. Okhawere, MD, MPH, Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, and colleagues.

This study aimed to compare health care costs and utilization 1 year after open radical prostatectomy vs robotic-assisted radical prostatectomy using 3 main outcomes measures: total health care cost including reimbursement paid by insurers and out of pocket costs by patients; healthcare utilization, including inpatient readmission, emergency department, hospital outpatient, and office visits; and estimated days missed from work due to health care utilization.

A US commercial claims database was used to identify men aged 18 to 64 years who underwent inpatient radical prostatectomy for prostate cancer between January 2013 and December 2018, and who were continuously enrolled with medical and prescription drug coverage from 180 days before to 365 days after inpatients prostatectomy.

Researchers performed an inverse probability of treatment weighting analysis to examine differences in costs and utilization of health care services by surgical method. Data analysis was conducted between September 2019 to July 2020.

A total of 11,457 patients were identified and included in the study. Of whom, 1694 (14%) received open radical prostatectomy and 9853 (86%) received robotic-assisted radical prostatectomy.

Patients who underwent robotic-assisted radical prostatectomy had higher cost at the index hospitalization compared to those who underwent open radical prostatectomy (mean difference, $2367; 95% CI, $1821-$2914; P <.001). Similar total cumulative costs were observed within 180 days (mean difference, $397; 95% CI, −$582 to $1375; P = .43) and 1 year after discharge (−$383; 95% CI, −$1802 to $1037; P = .60) between the 2 groups.

Regarding health care utilization, 1-year postdischarge health care use was significantly lower among those who underwent robotic-assisted vs open radical prostatectomy for mean numbers of emergency department visits (−0.09 visits; 95% CI, −0.11 to −0.07 visits; P <.001) and hospital outpatient visits (−1.5 visits; −1.63 to −1.36 visits; P <.001). The lower use of health care services among those who received robotic-assisted radical prostatectomy resulted in additional cost savings of $2929 (95% CI, $1600-$4257; P <.001) and approximately 1.69 fewer days (95% CI, 1.49-1.89 days; P <.001) missed from work for health care visits.

“The results of this study suggest that the total cumulative health care cost is equivalent when comparing ORP [open radical prostatectomy] and RARP [robotic-assisted radical prostatectomy] procedures 1 year after surgery,” Dr Okhawere and colleagues concluded.

“Robotic may be associated with lower postdischarge health care use, which may offset the higher costs during the index hospitalization,” they added.