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Robotic Cystectomy Costing Study

Robotic Cystectomy Costing Study. Douglas S. Scherr, MD Department of Urology The New York Presbyterian Hospital Weill Medical College of Cornell University. Background. Objective: to measure the economic impact of open vs. robotic cystectomy with urinary diversion

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Robotic Cystectomy Costing Study

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  1. Robotic Cystectomy Costing Study Douglas S. Scherr, MD Department of Urology The New York Presbyterian Hospital Weill Medical College of Cornell University

  2. Background • Objective: to measure the economic impact of open vs. robotic cystectomy with urinary diversion • Urinary diversions: ileal conduit, Indiana pouch, ileal neobladder

  3. Methods • Methods • Costing • Direct: surgeon’s fee, OR fee, anesthesia fee, PACU cost, inpatient hospital cost, cost of equipment (da Vinci Surgical System, Intuitive Surgical, Inc.) • Procedural costs: defined by 50th percentile of Medicare Resource Based Relative Value Scale (RBRVS) • Indirect: cost of complications • Complication rates derived from Cornell prospectively maintained database • Procedural costs derived from Medicare RBRVS

  4. Methods • Assumptions • Cost of da Vinci Surgical System: $1M • Cost of da Vinci Surgical System service contract: $100k per year • 7 year depreciation for da Vinci Surgical System • Assume equal robotic cost overhead between all robotic cases • 3 year avg Cornell robotic case volume: 269 cases • Robotic cost burden per case: $904 ($3488 for all robotic case-associated materials)

  5. Methods • Assumptions • Any readmission over any of time after cystectomy and urinary diversion counted as complication (WORST CASE scenario)

  6. Data

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  11. Results

  12. Sensitivity Analysis • Breakeven condition: How few robotic cases would need to be done per annum to make the cost of robotic cystectomy equal to open cystectomy, ceteris paribus? • Ileal conduit: 5 cases ($130,460) • Indiana pouch: 3 cases ($180,982) • Ileal neobladder: 7 cases ($127,826)

  13. Sensitivity Analysis • Breakeven condition: How few robotic cases would need to be done per annum to make the cost of robotic cystectomy equal to open cystectomy, assuming a 25% complication rate in each group? • Ileal conduit: 8 cases ($111,793) • Indiana pouch: 4 cases ($156,518) • Ileal neobladder: 8 cases ($113,039)

  14. Results • The impact of decreased length of stay (LOS) with robotic cystectomy outweighs the marginal cost impact of a da Vinci robotic system!

  15. Caveats • Small surgical series: results need to be re-examined in the context of greater surgical volume • Tertiary care, academic referral center: results may not be generalizable • Complications data may be undercaptured

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