At One Year, Health Care Costs Do Not Differ Between Open vs. Robotic-Assisted Radical Prostatectomy

Despite differences in costs upfront, patients with prostate cancer who undergo open radical prostatectomy (ORP) versus robotic-assisted radical prostatectomy (RARP) have similar health care costs one year after treatment, a study found.

“These findings suggest that lower postdischarge health care use after robotic-assisted prostatectomy may offset the higher costs during the index hospitalization,” the researchers explained.

They retrospectively reviewed U.S. commercial claims data spanning Jan. 1, 2013, through Dec. 31, 2018, identifying 11,457 patients with prostate cancer who underwent inpatient radical prostatectomy. All men were aged 18 to 64 years and were continuously enrolled with medical and prescription drug coverage from 180 days prior to 365 days following surgery. The study authors implemented an inverse probability of treatment weighing analysis to compare costs and use of health care services between patients who underwent ORP (n=1,604) versus RARP (n=9,853).

The primary outcomes assessed at one year postoperatively were total health care costs, including reimbursement paid by insurers and patients’ out-of-pocket costs; health care use, including inpatient readmission as well as emergency department (ED), hospital outpatient, and office visits; and estimated days missed from work due to health care use.

The majority of patients were aged between 55 and 64 years (n=8,467). Patients in the RARP group, compared to those who received ORP, paid more at the time of the index hospitalization, with a mean difference of $2,367 (95% confidence interval [CI], $1,821 to $2,914; P<0.001). However, cumulative costs did not largely differ between the groups by 180 days, with a mean difference of $397 (95% CI, ­–$582 to $1,375; P=0.43), or at one year, with a mean difference of –$383 (95% CI, –$1,802 to $1,037; P=0.60). At one year, patients in the RARP group, compared to the ORP group, had significantly fewer ED visits (–0.09 visits; 95% CI, −0.11 to −0.07; P<0.001) and hospital outpatient visits (−1.5 visits; 95% CI, −1.63 to −1.36; P<0.001). As a result of utilizing fewer health care services, patients in the RARP group yielded an additional savings of $2,929 (95% CI, $1,600 to $4,257; P<0.001) and missed fewer days of work for health care visits (1.69 fewer days; 95% CI, 1.49 to 1.89; P<0.001).

The study was published in JAMA Network Open.

“The results of this study suggest that the total cumulative health care cost is equivalent when comparing ORP and RARP procedures 1 year after surgery. Robotic may be associated with lower postdischarge health care use, which may offset the higher costs during the index hospitalization,” the researchers wrote in their conclusion.