Study Compares Out-of-pocket Costs for Robotic versus Open Surgery for Cancer

A retrospective, cross-sectional study comparing out-of-pocket costs for cancer patients who received robotic versus open surgical treatment observed that the former treatment may result in lower costs. The findings were recently published in JAMA Network Open.

“To truly understand whether robotic surgery is beneficial compared with open surgery, it is important to capture all costs borne by the patient, not just those covered by payers. Furthermore, understanding the specific segment of patients affected by the costs of a particular procedure may help better elucidate the factors associated with growing health inequity,” explained the researchers. “To examine this question, we used a large, nationally representative sample of patients to assess [out-of-pocket] costs and total payments for 5 types of common oncologic procedures that can be performed using an open or robotic approach.”

The study authors evaluated deidentified insurance claims for 1.9 million enrollees using the MarketScan database. Patients who were eligible for inclusion were aged between 18 and 64 years; were enrolled in an employer-sponsored health plan; and underwent an open or robotic radical prostatectomy, hysterectomy, partial colectomy, radical nephrectomy, or partial nephrectomy for a solid-organ malignant neoplasm. The primary outcome was out-of-pocket costs associated with robotic versus open surgery; the secondary outcome was associated total payments.

Final analysis included 15,893 patients (mean [SD] age, 55.4 [6.6] years; 11,102 were male), of whom 8,260 received robotic and 7,633 received open surgeries. Robotic hysterectomy patients were older than open hysterectomy patients (mean [SD] age, 55.7 [6.7] vs. 54.6 [7.2] years). More comorbidities were observed in open radical nephrectomy patients (≥2 comorbidities, 658 of 861 [76.4%]) than robotic radical nephrectomy patients (≥2 comorbidities, 244 of 347 [70.3%]).

When adjusting for baseline characteristics, out-of-pocket costs for all robotic procedures was lower compared to open surgery: radical prostatectomy, –$137.75 (95% CI, −$240.24 to −$38.63; P=0.006); hysterectomy, −$640.63 (95% CI, −$933.62 to −$368.79; P<0.001); radical nephrectomy, –$728.32 (95% CI, −$1126.90 to −$366.08; P<0.001); and partial nephrectomy, –$302.74 (95% CI, −$523.14 to −$97.10; P=0.003). Adjusted total payments were also lower for robotic surgeries compared to open: radial prostatectomy, –$3,872.62 (95% CI, −$5,385.49 to −$2,399.04; P<0.001); hysterectomy, –$29,640.69 (95% CI, −$36,243.82 to −$23,465.94; P<0.001); partial colectomy, –$38,151.74 (95% CI, −$46,386.16 to −$30,346.22; P<0.001); radical nephrectomy, –$33,394.15 (95% CI, −$42,603.03 to −$24,955.20; P<0.001); and partial nephrectomy, –$9,162.52 (95% CI, −$12,728.33 to −$5,781.99; P<0.001).

“We observed significant variation in perioperative costs according to surgical technique for both patients ([out-of-pocket] costs) and payers (total payments), with the robotic approach associated with significantly lower [out-of-pocket] costs for all studied oncologic procedures,” concluded the researchers. “These results highlight the complexity of economic factors that are associated with the rapid adoption and possible subsidization of the robotic approach for common surgically amenable conditions and lay a foundation for future work on this issue.”