Robot-assisted prostate surgery may be a profit-sink for hospitals, according to a new study set to be published in the July issue of the journal Urology.
Researchers looking at direct and indirect costs of robot-assisted prostatectomy compared with standard open surgery concluded that providers lost nearly $5,300 per patient on average when opting for the higher-tech procedure, results which market leader Intuitive Surgical (NSDQ:ISRG) views as problematic.
"They don’t have any clinical outcomes in there," Intuitive Surgical chief medical advisor Myriam Curet told MassDevice.com today.
Prior studies have suggested that complication and mortality rates are lower for procedures conducted with robot assistance, but no randomized studies have yet to compare open surgery and robot-assisted prostatectomy directly. In a health care environment ruled by pricing pressures and cost concerns, health providers are eager to ensure that they’re getting the most bang for their buck in terms of new technology.
Robot-assisted surgery has become the preferred means of prostatectomy during the last decade, but the data demonstrating a conclusive benefit to the high-tech option is limited, researchers warned.
"Nearly 240,000 new cases of prostate cancer are diagnosed annually, and radical prostatectomy is the most common treatment," Nelson said. "It is reasonable to question whether the increased costs of this robotic-assisted approach are justified."
"It’s really about cost-effectiveness, not just about acquisition costs," Curet told us. "If you look at the entirely of costs, including recovery and everything like that, we bring value there."
"When you have a 3-fold increase in mortality in an open procedure compared to robotic, I think that’s a pretty powerful argument about bringing benefits to a patient, and that needs to be considered in the cost-analysis," she added.
The study authors looked at 473 real prostatectomies, 115 with the robot and 338 without, which took place at the University of Pittsburgh School of Medicine Shadyside hospital between July 2009 and October 2010, according to a press release.
The study found that the hospital lost more than $4,000 per patient when conducting prostatectomy with robot-assistance, but payments exceeded costs by more than $1,300 for the standard approach. Insurers and Medicare programs pay out the same amount for both standard and robot-assisted prostatectomy, so any differences in cost must either be reflected in the hospital’s fee or its loss.
"Our study suggests that our society may be paying too high a price for what has been widely perceived as a medical advance," senior study author Dr. Joel Nelson said in prepared remarks. "The value of that care for patients is of particular concern to a nation struggling to control health care costs while improving outcomes."
The researchers attributed most of the cost hike to robotic equipment and supplies, but Curet said their numbers are unusual.
"There’s not a lot of information there about how they determine these supply costs," she told us. "We know from our own internal data about how many instruments a typical prostatectomy uses and their OR supply cost suggests they’re using almost twice as many instruments as surgeons typically use."
"We’ve actually not increased our instrument prices in over 10 years," Curet added. "We are very cost-conscious and we have been very careful to hold costs steady and not increase them."