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The introduction, adoption and proliferation of new technology and therapies in healthcare often occur without regard to cost. Instead, improved outcomes, such as survival or quality of life (QoL), with one treatment versus another, tend to be the main determinant of adoption. In addition, increasingly informed healthcare consumers are also driving demand for the newest technologies. However, cost can play a role in the willingness of a hospital and healthcare systems to acquire novel medical devices and treatments. With cost being a major concern for purchasers of healthcare, evaluations of the cost-effectiveness of new technologies, such as robotic-assisted surgery, are needed to identify the optimal use of a fixed amount of resources.
Since the approval of the first robotic surgical system in the USA in 1999, robotic-assisted laparascopic procedures have exploded into almost every aspect of urology, as well as other surgical fields. Every procedure that can be performed laparoscopically is increasingly being performed with robotic assistance. Even procedures where laparoscopy has had no role are being performed with robotic assistance, such as vasovasostomy. According to Intuitive Surgical (Sunnyvale, CA, USA), the publicly traded company that sells the da Vinci ® robot and associated equipment, 1395 robotic systems have been installed worldwide, with 1028 in the USA and 248 in Europe [101]. In 2009 alone, over 200,000 robotic-assisted procedures were performed by various surgical specialties, including approximately 90,000 robotic-assisted laparoscopic prostatectomies (RALPs) [101]. For comparison, approximately 50,000 RALPs were performed in 2007 [1]. In the evolving field of robotic surgery, literature regarding cost-effectiveness is quite sparse. This article will review basic concepts of cost analysis in healthcare economics and review their application to robotic surgery in urology. Given that close to half of all robotic procedures are performed for prostate cancer the main focus will be on RALP. It is probable that some of the economic considerations for RALP can be extrapolated to other types of robotic surgery. As a basis for the article, we searched PubMed and Ovid for articles related to robotic surgery in urology and cost analyses related to the robot.
Cost-effectiveness in healthcare
With healthcare expenditures growing at unsustainable rates, economic analysis of medical decisions will probably play a greater role in the future with regard to the procurement of...