Hospitalization costs for radical prostatectomy attributable to robotic surgery

Background: With health technology innovation responsible for higher health care costs, it is essential to have accurate estimates regarding the differential costs between robot-assisted radical prostatectomy (RARP) and open radical prostatectomy (ORP). Objective: To describe the total hospitalization costs attributable to robotic and open surgery for radical prostatectomy (RP). Design, setting, and participants: Using a population-based cohort by merging the Nationwide Inpatient Sample (NIS) and the American Hospital Association (AHA) survey from 2006 to 2008, we identified 29 837 prostate cancer patients who underwent RP. Interventions: ORP and RARP. Outcome measurements and statistical analysis: The primary outcome was total hospitalization costs adjusted to year 2008 US dollars. Generalized estimating equations were used to identify patient and hospital characteristics associated with total hospitalization costs and to estimate costs of ORP and RARP adjusted for case mix and hospital teaching status, location, and annual case volume. Results and limitations: Overall, 20 424 (68.5%) patients were surgically treated with RARP, and 9413 (31.5%) patients underwent ORP. Compared to ORP, patients undergoing RARP had shorter median length of stay (1 d vs 2 d; p < 0.001) and were less likely to experience any postoperative complications (8.2% vs 11.3%; p < 0.001). However, patients undergoing RARP had higher median hospitalization costs ($10 409 vs $8862; p < 0.001). After adjusting for patient and hospital features, RARP was associated with higher total hospitalization costs compared to ORP ($11 932 vs $9390; p < 0.001). Our results are limited by a study design using retrospective population-based data. Conclusions: Despite RARP having lower complications and shorter length of stay than ORP, total hospitalization costs are higher for patients treated with RARP compared with those treated with ORP.