Cost comparison of robotic, laparoscopic, and open partial nephrectomy

Purpose: To compare direct costs associated with open partial nephrectomy (OPN), laparoscopic partial nephrectomy (LPN), and robot-assisted LPN (RALPN). Methods: A meta-analysis of nonoverlapping studies was performed to determine operating room (OR) time, equipment use, and length of stay (LOS) for OPN, LPN, and RALPN. Cost models using cost data obtained from our institution were created, and robotic cost and maintenance were amortized over 7 years. One- and two-way sensitivity analyses were performed to evaluate the effect of changing variables on the cost effectiveness of each approach. Results: Seven RALPN, 18 LPN, and 8 OPN data series were identified, comprising a total of 477, 2220, and 2745 procedures, respectively. Weighted mean OR time was 188, 200, 193 minutes; weighted mean LOS was 2.6, 3.2, and 5.9 days for RALPN, LPN, and OPN, respectively. LPN was the most cost-effective approach at a mean direct cost of $10,311, with a cost advantage of $1116 and $1652 over OPN ($11,427) and RALPN ($11,962), respectively. Sensitivity analyses demonstrate that significant decreases in robotic costs are required for RALPN to be cost effective. Conclusion: Despite similar OR times, LPN is more cost effective than OPN because of shorter LOS. Because of lower instrumentation costs, LPN is the most cost effective despite a longer LOS than RALPN. RALPN has high cost of maintenance and instrumentation, which is partially compensated by the shorter LOS. Evidence of oncological and functional equivalence to OPN is warranted to determine the future role of RALPN.