Cost comparison of robot-assisted and laparoscopic pyeloplasty

Background and Purpose: Laparoscopic repair of ureteropelvic junction obstruction is now the standard of care at many institutions. The objective of this study is to compare costs associated with robot-assisted pyeloplasty (RP) vs laparoscopic pyeloplasty (LP). Materials and Methods: A decision analysis model was developed to compare costs of each procedure based on hospital-related cost centers. A literature search was performed to identify nonoverlapping studies with outcomes for RP and LP. Weighted means were calculated for operative time and length of stay. Cost data were obtained from our institution. One- and two-way sensitivity analyses were performed to evaluate the effect of changing variables on the cost-effectiveness of RP. Results: Eight studies were identified with 181 and 145 patients undergoing RP or LP, respectively. Operative times were 211 minutes for RP and 224 minutes for LP. Hospital stays were shorter for RP at 1.54 days compared with 1.98 days for LP. Mean direct costs were higher for RP at $10,635 vs $9,065 for LP. The largest difference was in fixed surgical supply costs per case at $1357 for RP and $406 for LP. One-way sensitivity analysis showed that RP would be cost effective if performed in less than 96 minutes. Even if RP was performed on an outpatient basis or more than 1000 cases/year, however, LP would still be cost superior. Two-way analyses showed areas where RP could be more cost-effective than LP. Conclusions: RP is associated with higher cost compared with LP, predominately because of the cost of the robot and surgical supply costs. Decreasing operative time and equipment costs may result in RP being more cost-effective than LP. Shorter hospital stay alone, however, is insufficient to allow RP to be cost-effective. One would need to demonstrate tangible advantages to the robot to justify the added costs.