Cost-Effectiveness Backgrounders Media Company Home da Vinci Surgery can be a cost-effective approach for many surgical procedures. Numerous studies demonstrate the cost benefits of robotic-assisted surgery for appropriate procedures, as compared to alternative treatment methods. There are two main categories of cost analysis, and while both have strengths and limitations as to data generated, they provide an important basis for considering cost impacts. Hospital-Level Direct Cost Studies There are a number of factors that determine the cost-effectiveness of an advanced technology. For that reason, well-designed direct cost studies measure total treatment costs to provide the best insight into hospital costs. These include, but are not limited to, direct operating room costs, length of stay, complications, blood transfusions, readmissions and equipment amortization. The most accurate studies compare the total costs of robotic-assisted surgery to the total costs of the appropriate alternative treatment, which most often is traditional open surgery. They use actual direct costs from hospital accounting systems – not charge rates, estimates or burdened costs that include overhead allocations. Actual da Vinci Surgical System usage is always an important input within this calculation. Initial technology investment evens out over the longer-term as usage increases. Studies that evaluate a hospital's direct costs during its early da Vinci Surgery experience and/or hospitals that use the system at low volumes do not provide an accurate picture of the long-term system and service costs. Cost to Health Care System: Large Database Studies Large database studies and meta-analyses can also provide value and may be generalizable to larger trends. They cannot, however, provide accurate cost data at the hospital level. This is because many hospital costs are either not available in national databases, or the cost methodologies vary across institutions. The most well-designed large database studies model the costs and effects of relative rates of complications across different surgical methods. They also illustrate changes in the mixture of therapeutic methods used (open surgery versus minimally invasive surgery) over time and their economic implications. Inclusion Criteria For Hospital based studies, the paper must study a current standardized robotic procedure, and present actual cost data (not charges) in a large enough sample size to evaluate the procedure. The comparison arms must at least include the surgical or medical alternative that would otherwise be performed, in addition to any other comparison arms. Cost data that were considered to be complete included all direct operating room costs (supplies, instruments, labor), length of stay (with associated costs), costs associated with complications, blood transfusions, and equipment amortization and maintenance with stated assumptions. Papers were mostly excluded for not meeting primary inclusion criteria. Some papers from several years prior with otherwise appropriate methodology were excluded for covering older procedures or non-standard techniques that have changed significantly since the data were collected, and are therefore of limited applicability to current practitioners. For database studies, the inclusion criteria were sufficient transparency and applicability of methods such that the results could be interpreted by current clinicians. In addition, more weight was given to studies in which the data examined larger clinical trends evolving over time. The following robotic-assisted surgery cost studies, with varying conclusions, are examples of well-designed economic analyses. We will periodically update this listing. General Robotic (1) • Epstein, A. J. G., P. W.; Harhay, M. O.; Yang, F.; Polsky, D. (2013). "Impact of Minimally Invasive Surgery on Medical Spending and Employee Absenteeism." JAMA Surg: 1-7. View Article Gynecology (6) • Bell, M. C. T., J.; Seshadri-Kreaden, U.; Suttle, A. W.; Hunt, S. (2008). "Comparison of outcomes and cost for endometrial cancer staging via traditional laparotomy, standard laparoscopy and robotic techniques." Gynecologic Oncology 111(3): 407-411. View Article • Halliday, D. L., S.; Vaknin, Z.; Deland, C.; Levental, M.; McNamara, E.; Gotlieb, R.; Kaufer, R.; How, J.; Cohen, E.; Gotlieb, W. H. (2010). "Robotic radical hysterectomy: comparison of outcomes and cost." Journal of Robotic Surgery: 1-6. View Article • Hoyte, L. R., R.; Mezzich, J.; Bassaly, R.; Downes, K. (2012). "Cost analysis of open versus robotic-assisted sacrocolpopexy." Female Pelvic Med Reconstr Surg 18(6): 335-339. View Article • Landeen, L. B. B., M. C.; Hubert, H. B.; Bennis, L. Y.; Knutsen-Larson, S. S.; Seshadri-Kreaden, U. (2011). "Clinical and cost comparisons for hysterectomy via abdominal, standard laparoscopic, vaginal and robot-assisted approaches." South Dakota Medicine 64(6): 197-199, 201, 203 passim. View Article • Lau, S. V., Z.; Ramana-Kumar, A. V.; Halliday, D.; Franco, E. L.; Gotlieb, W. H. (2012). "Outcomes and cost comparisons after introducing a robotics program for endometrial cancer surgery." Obstetrics and Gynecology 119(4): 717-724. View Article • Reynisson, P. P., J. (2013). "Hospital costs for robot-assisted laparoscopic radical hysterectomy and pelvic lymphadenectomy." Gynecol Oncol. View Article Thoracic (1) • Park, B. J. F., R. M. (2008). "Cost Comparison of Robotic, Video-assisted Thoracic Surgery and Thoracotomy Approaches to Pulmonary Lobectomy." Thoracic Surgery Clinics 18(3): 297-300. View Article Urology (6) • Alemozaffar, M. C., S. L.; Kacker, R.; Sun, M.; Dewolff, W. C.; Wagner, A. A. (2012). "Comparing Costs of Robotic, Laparoscopic, and Open Partial Nephrectomy." J Endourol. View Article • Cooperberg, M. R. R., N. R.; Duff, S. B.; Hughes, K. E.; Sadownik, S.; Smith, J. A.; Tewari, A. K. (2012). "Primary treatments for clinically localised prostate cancer: a comprehensive lifetime cost-utility analysis." BJU Int. View Article • Hohwü, L. B., M.; Ehlers, L.; Venborg Pedersen, K. (2011). "A short-term cost-effectiveness study comparing robot-assisted laparoscopic and open retropubic radical prostatectomy." Journal of Medical Economics 14(4): 403-409. View Article • Martin, A. D. N., R. N.; Castle, E. P. (2011). "Robot-assisted radical cystectomy versus open radical cystectomy: A complete cost analysis." Urology 77(3): 621-625. View Article • Morgan, J. A. T., B. A.; Peacock, J. C.; Hollingsworth, K. W.; Smith, C. R.; Oz, M. C.; Argenziano, M. (2005). "Does robotic technology make minimally invasive cardiac surgery too expensive? A hospital cost analysis of robotic and conventional techniques." J Card Surg 20(3): 246-251. View Article Serious complications may occur in any surgery, including da Vinci® Surgery, up to and including death. Examples of serious or life-threatening complications, which may require prolonged and/or unexpected hospitalization and/or reoperation, include but are not limited to, one or more of the following: injury to tissues/organs, bleeding, infection and internal scarring that can cause long-lasting dysfunction/pain. Risks of surgery also include the potential for equipment failure and/or human error. Individual surgical results may vary. Risks specific to minimally invasive surgery, including da Vinci Surgery, include but are not limited to, one or more of the following: temporary pain/nerve injury associated with positioning; temporary pain/discomfort from the use of air or gas in the procedure; a longer operation and time under anesthesia and conversion to another surgical technique. If your doctor needs to convert the surgery to another surgical technique, this could result in a longer operative time, additional time under anesthesia, additional or larger incisions and/or increased complications. Patients who are not candidates for non-robotic minimally invasive surgery are also not candidates for da Vinci® Surgery. Patients should talk to their doctor to decide if da Vinci Surgery is right for them. Patients and doctors should review all available information on non-surgical and surgical options in order to make an informed decision. For Important Safety Information, including surgical risks, indications, and considerations and contraindications for use, please also refer to http://www.intuitivesurgical.com/safety. Unless otherwise noted, all people depicted are models. © 2014 Intuitive Surgical. All rights reserved. All product names are trademarks or registered trademarks of their respective holders.