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Chirurgie robot-assistée en uro-oncologie. ONCOLOGIE 2016. [DOI: 10.1007/s10269-016-2622-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Leow JJ, Chang SL, Meyer CP, Wang Y, Hanske J, Sammon JD, Cole AP, Preston MA, Dasgupta P, Menon M, Chung BI, Trinh QD. Robot-assisted Versus Open Radical Prostatectomy: A Contemporary Analysis of an All-payer Discharge Database. Eur Urol 2016; 70:837-845. [PMID: 26874806 DOI: 10.1016/j.eururo.2016.01.044] [Citation(s) in RCA: 155] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 01/22/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND More than a decade since its inception, the benefits and cost efficiency of robot-assisted radical prostatectomy (RARP) continue to elicit controversy. OBJECTIVE To compare outcomes and costs between RARP and open RP (ORP). DESIGN, SETTING, AND PARTICIPANTS A cohort study of 629 593 men who underwent RP for localized prostate cancer at 449 hospitals in the USA from 2003 to 2013, using the Premier Hospital Database. INTERVENTION RARP was ascertained through a review of the hospital charge description master for robotic supplies. OUTCOME MEASURES AND STATISTICAL ANALYSIS Outcomes were 90-d postoperative complications (Clavien), blood product transfusions, operating room time (ORT), length of stay (LOS), and direct hospital costs. Propensity-weighted regression analyses accounting for clustering by hospitals and survey weighting ensured nationally representative estimates. RESULTS AND LIMITATIONS RARP utilization rapidly increased from 1.8% in 2003 to 85% in 2013 (p<0.001). RARP patients (n=311 135) were less likely to experience any complications (odds ratio [OR] 0.68, p<0.001) or prolonged LOS (OR 0.28, p<0.001), or to receive blood products (OR 0.33, p=0.002) compared to ORP patients (n=318 458). The adjusted mean ORT was 131min longer for RARP (p=0.002). The 90-d direct hospital costs were higher for RARP (+$4528, p<0.001), primarily attributed to operating room and supplies costs. Costs were no longer signficantly different between ORP and RARP among the highest-volume surgeons (≥104 cases/yr; +$1990, p=0.40) and highest-volume hospitals (≥318 cases/yr; +$1225, p=0.39). Limitations include the lack of oncologic characteristics and the retrospective nature of the study. CONCLUSIONS Our contemporary analysis reveals that RARP confers a perioperative morbidity advantage at higher cost. In the absence of large randomized trials because of the widespread adoption of RARP, this retrospective study represents the best available evidence for the morbidity and cost profile of RARP versus ORP. PATIENT SUMMARY In this large study of men with prostate cancer who underwent either open or robotic radical prostatectomy, we found that robotic surgery has a better morbidity profile but costs more.
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Affiliation(s)
- Jeffrey J Leow
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA; Department of Urology, Tan Tock Seng Hospital, Singapore
| | - Steven L Chang
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA; Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Christian P Meyer
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Ye Wang
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Julian Hanske
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Jesse D Sammon
- VUI Center for Outcomes Research Analytics and Evaluation (VCORE), Henry Ford Health System, Detroit, MI, USA
| | - Alexander P Cole
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mark A Preston
- Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Prokar Dasgupta
- Department of Urology, King's College London, Guy's and St. Thomas' Hospitals NHS Foundation Trust, Guy's Hospital, London, UK
| | - Mani Menon
- VUI Center for Outcomes Research Analytics and Evaluation (VCORE), Henry Ford Health System, Detroit, MI, USA
| | - Benjamin I Chung
- Department of Urology, Stanford University Medical Center, Stanford, CA, USA
| | - Quoc-Dien Trinh
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA; Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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Sanyal C, Aprikian AG, Cury FL, Chevalier S, Dragomir A. Management of localized and advanced prostate cancer in Canada: A lifetime cost and quality-adjusted life-year analysis. Cancer 2016; 122:1085-96. [PMID: 26828716 DOI: 10.1002/cncr.29892] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 12/18/2015] [Accepted: 12/21/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND To the authors' knowledge, the literature to date lacks studies examining lifetime costs and quality-adjusted life-years (QALYs) of prostate cancer (PCa) management strategies that integrate localized and advanced disease. The objective of the current study was to assess lifetime costs and QALYs associated with contemporary PCa management strategies across risk groups by integrating localized and advanced disease. METHODS The authors' validated Markov chain Monte Carlo model was used to predict lifetime direct costs and QALYs. The health states modeled were active surveillance, initial treatments (radical prostatectomy or radiotherapy), PCa recurrence, PCa recurrence free, metastatic castration-resistant prostate cancer, and death (cause specific/other causes). Data regarding treatment distribution, state transition probabilities, adverse effects of management options, costs, utilities, and disutilities were derived from the published literature. RESULTS The total cost per patient for the overall cohort increased from $18,503 at 5 years to $28,032 and $39,143, respectively, at 10 years and 15 years. Furthermore, the results indicated the influence of risk group on total cost, with the high-risk group accruing the maximum per patient cost followed by the intermediate-risk and low-risk groups. Active surveillance was found to confer the most QALYs (12.5 years) and was the least costly strategy ($18,452) for individuals at low risk. For all risk groups, radical prostatectomy was less costly and conferred modestly more QALYs compared with intensity-modulated radiotherapy modalities. CONCLUSIONS Public health care systems in Canada and elsewhere are operating under budget constraints to allocate finite resources. The findings of the current study might inform discussions concerning budget planning to provide health care services.
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Affiliation(s)
| | - Armen G Aprikian
- Department of Urology, McGill University, Montreal, Quebec, Canada.,Research Institute of McGill University Health Center, Montreal, Quebec, Canada
| | - Fabio L Cury
- Department of Urology, McGill University, Montreal, Quebec, Canada.,Division of Radiation Oncology, McGill University Health Center, Montreal, Quebec, Canada
| | - Simone Chevalier
- Department of Urology, McGill University, Montreal, Quebec, Canada.,Research Institute of McGill University Health Center, Montreal, Quebec, Canada
| | - Alice Dragomir
- Department of Urology, McGill University, Montreal, Quebec, Canada.,Research Institute of McGill University Health Center, Montreal, Quebec, Canada
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Hughes D, Camp C, O'Hara J, Adshead J. Health resource use after robot-assisted surgery vs open and conventional laparoscopic techniques in oncology: analysis of English secondary care data for radical prostatectomy and partial nephrectomy. BJU Int 2016; 117:940-7. [DOI: 10.1111/bju.13401] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- David Hughes
- HCD Economics; Daresbury UK
- Faculty of Health and Social Care; University of Chester; Chester UK
| | | | - Jamie O'Hara
- HCD Economics; Daresbury UK
- Faculty of Health and Social Care; University of Chester; Chester UK
| | - Jim Adshead
- Hertfordshire and South Bedfordshire Urological Cancer Centre; Department of Urology; Lister Hospital; Stevenage UK
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56
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Reimbursement for Prostate Cancer Treatment. Prostate Cancer 2016. [DOI: 10.1016/b978-0-12-800077-9.00041-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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57
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Favorito LA. Editorial in this issue - Bladder Neck Reconstruction in Radical Prostatectomy: What we still can learn and improve? Int Braz J Urol 2015. [PMID: 26200531 PMCID: PMC4752129 DOI: 10.1590/s1677-5538.ibju.2015.03.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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58
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Horie S. The healthcare economics of medication for prostate cancer. Prostate Int 2015. [DOI: 10.1016/j.prnil.2015.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Perlbarg J, Rabetrano H, Soulié M, Salomon L, Durand-Zaleski I. [Economic evaluation of the treatments of non-metastatic prostate cancer]. Prog Urol 2015; 25:1108-15. [PMID: 26519969 DOI: 10.1016/j.purol.2015.07.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Accepted: 07/29/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Prostate cancer is the most frequent cancer and the third leading cause of cancer death in men in France. The development of treatment for prostate cancer is fast and sometimes relies on costly innovations. Medico-economic studies are however rare in this area. This literature review aims to summarize available medico-economic data on the initial management of localized prostate cancer and discuss the quality and usability of existing economic studies on the subject. MATERIALS AND METHOD Literature review was done using PubMed and Cochrane databases. Studies and articles were selected based on several criteria: population with initial treatment for localized prostate cancer (without metastasis), comparative studies with surgery as control treatment, studies in countries members of the OECD, articles in English or French published between 2004 and 2014. RESULTS The surgical robot, one of the newest innovations, is more expensive than conventional open surgery or no robotic laparoscopy, even if it is associated with a reduction of the original period of stay. Radiation therapy seems more expensive than surgery as initial therapy of localized prostate cancer. CONCLUSION Conclusions remain limited because of the rarity of reliable health economic studies on the subject.
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Affiliation(s)
- J Perlbarg
- URC-Eco (unité de recherche clinique spécialisée en économie de la santé), Hôtel-Dieu, AP-HP, 1, place du Parvis-Notre-Dame, 75004 Paris, France
| | - H Rabetrano
- URC-Eco (unité de recherche clinique spécialisée en économie de la santé), Hôtel-Dieu, AP-HP, 1, place du Parvis-Notre-Dame, 75004 Paris, France
| | - M Soulié
- Département d'urologie-andrologie-transplantation rénale, CHU Rangueil, 1, avenue Jean-Poulhès, 31059 Toulouse cedex 9, France
| | - L Salomon
- Service d'urologie et de transplantation rénale et pancréatique, CHU Mondor, 51, avenue Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France.
| | - I Durand-Zaleski
- URC-Eco (unité de recherche clinique spécialisée en économie de la santé), Hôtel-Dieu, AP-HP, 1, place du Parvis-Notre-Dame, 75004 Paris, France
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Gandaglia G, Montorsi F, Karakiewicz PI, Sun M. Robot-assisted radical prostatectomy in prostate cancer. Future Oncol 2015; 11:2767-73. [DOI: 10.2217/fon.15.169] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Since its introduction in the year 2000, robot-assisted radical prostatectomy (RARP) rapidly diffused, and nowadays roughly 70% of all the radical prostatectomies in the USA are performed using this approach. Interestingly, the broad dissemination of RARP occurred in the absence of comprehensive data coming from prospective randomized trials supporting the superiority of RARP versus the conventional open RP (ORP). Only observations originating from retrospective institutional or large population-based cohorts exist with respect to the comparative effectiveness of the two surgical techniques. What we have learned is that, given an adequate learning curve, RARP leads to better perioperative and long-term functional outcomes compared with ORP, without any compromise to cancer control outcomes. That being said, the substantially higher costs associated with the use of robotics cannot be ignored.
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Affiliation(s)
- Giorgio Gandaglia
- Urological Research Institute, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy
- Cancer Prognostics & Health Outcomes Unit, University of Montreal Health Center, 1058, rue St-Denis, Montreal (QC), H2X 3J4, Canada
| | - Francesco Montorsi
- Urological Research Institute, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy
| | - Pierre I Karakiewicz
- Cancer Prognostics & Health Outcomes Unit, University of Montreal Health Center, 1058, rue St-Denis, Montreal (QC), H2X 3J4, Canada
| | - Maxine Sun
- Cancer Prognostics & Health Outcomes Unit, University of Montreal Health Center, 1058, rue St-Denis, Montreal (QC), H2X 3J4, Canada
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Tandogdu Z, Vale L, Fraser C, Ramsay C. A Systematic Review of Economic Evaluations of the Use of Robotic Assisted Laparoscopy in Surgery Compared with Open or Laparoscopic Surgery. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2015; 13:457-67. [PMID: 26239361 DOI: 10.1007/s40258-015-0185-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND Robot assisted laparoscopic (RAL) surgery developed to overcome the limitations of laparoscopy to assist in surgical procedures, has high capital and operating costs. Systematically assembled evidence demonstrating its clinical and cost effectiveness would be helpful for its adoption by decision makers. OBJECTIVE To summarise the evidence on the cost-effectiveness of robot-assisted laparoscopic (RAL) surgery compared with relevant alternatives. Methods and results of identified studies were assessed to identify the deficiencies in evidence and areas for further research. METHODS Studies reporting both costs and outcomes for comparisons of RAL with laparoscopy and/or open surgery were systematically identified. Searches were conducted in February 2015 on MEDLINE, EMBASE and NHS EED. Quality of the included studies was assessed against a standard checklist for economic analyses. Length of hospital stay and operating time (determinants of cost), cost of intervention, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratio (ICER) were extracted. To aid comparison, costs were converted into a common currency and price year (2014 US dollars). RESULTS Forty-seven eligible studies were identified (full economic evaluation n = 6 and cost analysis n = 41). Economic models were used in 11 (23%) studies. Only three studies used a model considered representative of the disease and clinical pathway with a time-horizon allowing capture of relevant differences in outcomes across strategies. The cost of RAL varied substantially between uses, ranging from US$7011 for hysterectomy to over US$30,000 for radical cystectomy. The majority of estimates were between US$15,000 and US$25,000 per person. In part this difference is explained by the difference between studies in which costs were included. It was also identified to have higher costs than the alternatives it was compared against. Incremental cost per QALY for RAL radical prostatectomy was US$28,801-$31,763 over a 10-year period assuming 200 cases per annum. CONCLUSION The clinical evidence available for RAL overall and used within included studies is limited. RAL surgery costs were consistently higher than open and laparoscopic surgery. Therefore, in adopting the robotic technology decision makers need to take into account the cost effectiveness within their own systems. Economic models generated and published for radical prostatectomy and hysterectomy may be adapted to other health systems if the care pathway is similar to provide locally relevant data.
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Affiliation(s)
- Zafer Tandogdu
- Northern Institute for Cancer Research, Newcastle University, Newcastle Upon Tyne, UK
- Health Economics Group, Institute of Health and Society, Newcastle University, Newcastle Upon Tyne, UK
| | - Luke Vale
- Health Economics Group, Institute of Health and Society, Newcastle University, Newcastle Upon Tyne, UK
| | - Cynthia Fraser
- Health Services Research Unit, University of Aberdeen, 3rd Floor, Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Craig Ramsay
- Health Services Research Unit, University of Aberdeen, 3rd Floor, Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, UK.
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62
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Jensen CC, Madoff RD. Value of robotic colorectal surgery. Br J Surg 2015; 103:12-3. [PMID: 26768097 DOI: 10.1002/bjs.9935] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 08/12/2015] [Indexed: 12/13/2022]
Abstract
No patient benefit yet
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Affiliation(s)
- C C Jensen
- Division of Colon and Rectal Surgery, University of Minnesota, MMC 450, 420 Delaware Street SE, Minneapolis, Minnesota 55455, USA
| | - R D Madoff
- Division of Colon and Rectal Surgery, University of Minnesota, MMC 450, 420 Delaware Street SE, Minneapolis, Minnesota 55455, USA.
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Niklas C, Saar M, Berg B, Steiner K, Janssen M, Siemer S, Stöckle M, Ohlmann CH. da Vinci and Open Radical Prostatectomy: Comparison of Clinical Outcomes and Analysis of Insurance Costs. Urol Int 2015; 96:287-94. [PMID: 26159050 DOI: 10.1159/000431104] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 05/03/2015] [Indexed: 11/19/2022]
Abstract
PURPOSE To assess clinical outcomes and reimbursement costs of open and robotic-assisted radical prostatectomies in Germany. METHODS Perioperative data of 499 open (2003-2006) and 932 (2008-2010) robotic-assisted radical prostatectomies as well as longitudinal reimbursement costs of an anonymized health insurance research database from Germany containing data of patients who underwent robotic-assisted or open radical prostatectomy were retrospectively analysed in a single-centre study. RESULTS Significantly better outcomes after robotic-assisted vs. open prostatectomy were observed in regards to positive surgical margins (13.3 vs. 22.4%; p < 0.0001), intraoperative transfusions (0.1 vs. 2.6%; p < 0.0001), hospitalization (8.7 vs. 15.2 days; p < 0.0001) and duration of catheter (6.6 vs. 12.8 days; p < 0.0001). Operating time was significantly longer with robotic-assisted radical prostatectomy when compared to open surgery (184.4 vs. 128.0 min; p < 0.0001), while intraoperative complications showed a similar occurrence between both groups. Significant fewer postoperative complications were observed after robotic-assisted radical prostatectomy (26.5 vs. 42.5%; p < 0.0001) and rate of re-admission was lower for the robotic patients (13.6 vs. 19.4%; p = 0.0050). While insurance costs were higher in the 2 years before radical prostatectomy for the patients who underwent a robotic procedure (4,241.60 vs. 3,410.23 €; p = 0.202), additive costs of care of the year of surgery plus the 2 following years were less for the robotic cohort when compared to the costs incurred by the open group (21,673.71 vs. 24,512.37 €; p = 0.1676). CONCLUSIONS The observed clinical advantages of robotic-assisted radical prostatectomy seem to result in reduced health insurance cost postoperatively when compared to open surgery. This should be taken into consideration regarding reimbursement and implementation of a clinically superior method.
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Affiliation(s)
- Christina Niklas
- Saarland University Medical Center, Department of Urology and Pediatric Urology, Homburg/Saar, Germany
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Imkamp F, Herrmann TR, Tolkach Y, Dziuba S, Stolzenburg JU, Rassweiler J, Sulser T, Zimmermann U, Merseburger AS, Kuczyk MA, Burchardt M. Acceptance, Prevalence and Indications for Robot-Assisted Laparoscopy - Results of a Survey Among Urologists in Germany, Austria and Switzerland. Urol Int 2015; 95:336-45. [DOI: 10.1159/000430502] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 04/13/2015] [Indexed: 11/19/2022]
Abstract
Background: Robotic-assisted laparoscopy (RAL) is being widely accepted in the field of urology as a replacement for conventional laparoscopy (CL). Nevertheless, the process of its integration in clinical routines has been rather spontaneous. Objective: To determine the prevalence of robotic systems (RS) in urological clinics in Germany, Austria and Switzerland, the acceptance of RAL among urologists as a replacement for CL and its current use for 25 different urological indications. Materials and Methods: To elucidate the practice patterns of RAL, a survey at hospitals in Germany, Austria and Switzerland was conducted. All surgically active urology departments in Germany (303), Austria (37) and Switzerland (84) received a questionnaire with questions related to the one-year period prior to the survey. Results: The response rate was 63%. Among the participants, 43% were universities, 45% were tertiary care centres, and 8% were secondary care hospitals. A total of 60 RS (Germany 35, Austria 8, Switzerland 17) were available, and the majority (68%) were operated under public ownership. The perception of RAL and the anticipated superiority of RAL significantly differed between robotic and non-robotic surgeons. For only two urologic indications were more than 50% of the procedures performed using RAL: pyeloplasty (58%) and transperitoneal radical prostatectomy (75%). On average, 35% of robotic surgeons and only 14% of non-robotic surgeons anticipated RAL superiority in some of the 25 indications. Conclusions: This survey provides a detailed insight into RAL implementation in Germany, Austria and Switzerland. RAL is currently limited to a few urological indications with a small number of high-volume robotic centres. These results might suggest that a saturation of clinics using RS has been achieved but that the existing robotic capacities are being utilized ineffectively. The possible reasons for this finding are discussed, and certain strategies to solve these problems are offered.
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de Almeida JR, Moskowitz AJ, Miles BA, Goldstein DP, Teng MS, Sikora AG, Gupta V, Posner M, Genden EM. Cost-effectiveness of transoral robotic surgery versus (chemo)radiotherapy for early T classification oropharyngeal carcinoma: A cost-utility analysis. Head Neck 2015; 38:589-600. [DOI: 10.1002/hed.23930] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2014] [Indexed: 11/09/2022] Open
Affiliation(s)
- John R. de Almeida
- Department of Otolaryngology-Head and Neck Surgery; Princess Margaret Hospital; Toronto Canada
| | - Alan J. Moskowitz
- Departments of Health Evidence & Policy and Medicine; Icahn School of Medicine at Mount Sinai; New York New York
| | - Brett A. Miles
- Department of Otolaryngology-Head and Neck Surgery; Icahn School of Medicine at Mount Sinai; New York New York
| | - David P. Goldstein
- Department of Otolaryngology-Head and Neck Surgery; Princess Margaret Hospital; Toronto Canada
| | - Marita S. Teng
- Department of Otolaryngology-Head and Neck Surgery; Icahn School of Medicine at Mount Sinai; New York New York
| | - Andrew G. Sikora
- Department of Otolaryngology-Head and Neck Surgery; Icahn School of Medicine at Mount Sinai; New York New York
| | - Vishal Gupta
- Department of Radiation Oncology; Icahn School of Medicine at Mount Sinai; New York New York
| | - Marshall Posner
- Department of Medical Oncology; Icahn School of Medicine at Mount Sinai; New York New York
| | - Eric M. Genden
- Department of Otolaryngology-Head and Neck Surgery; Icahn School of Medicine at Mount Sinai; New York New York
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Soares R, Di Benedetto A, Dovey Z, Bott S, McGregor RG, Eden CG. Minimum 5-year follow-up of 1138 consecutive laparoscopic radical prostatectomies. BJU Int 2015; 115:546-53. [PMID: 25098710 DOI: 10.1111/bju.12887] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To investigate the long-term outcomes of laparoscopic radical prostatectomy (LRP). PATIENTS AND METHODS In all, 1138 patients underwent LRP during a 163-month period from 2000 to 2008, of which 51.5%, 30.3% and 18.2% were categorised into D'Amico risk groups of low-, intermediate- and high-risk, respectively. All intermediate- and high-risk patients were staged by preoperative magnetic resonance imaging or computed tomography and isotope bone scanning, and had a pelvic lymph node dissection (PLND), which was extended after April 2008. The median (range) patient age was 62 (40-78) years; body mass index was 26 (19-44) kg/m(2) ; prostate-specific antigen level was 7.0 (1-50) ng/mL and Gleason score was 6 (6-10). Neurovascular bundle was preservation carried out in 55.3% (bilateral 45.5%; unilateral 9.8%) of patients. RESULTS The median (range) gland weight was 52 (14-214) g. The median (range) operating time was 177 (78-600) min and PLND was performed in 299 patients (26.3%), of which 54 (18.0%) were extended. The median (range) blood loss was 200 (10-1300) mL, postoperative hospital stay was 3 (2-14) nights and catheterisation time was 14 (1-35) days. The complication rate was 5.2%. The median (range) LN count was 12 (4-26), LN positivity was 0.8% and the median (range) LN involvement was 2 (1-2). There was margin positivity in 13.9% of patients and up-grading in 29.3% and down-grading in 5.3%. While 11.4% of patients had up-staging from T1/2 to T3 and 37.1% had down-staging from T3 to T2. One case (0.09%) was converted to open surgery and six patients were transfused (0.5%). At a mean (range) follow-up of 88.6 (60-120) months, 85.4% of patients were free of biochemical recurrence, 93.8% were continent and 76.6% of previously potent non-diabetic men aged <70 years were potent after bilateral nerve preservation. CONCLUSIONS The long-term results obtainable from LRP match or exceed those previously published in large contemporary open and robot-assisted surgical series.
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Affiliation(s)
- Ricardo Soares
- Department of Urology, Royal Surrey County Hospital, Guildford, Surrey, UK
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Kim CW, Baik SH, Roh YH, Kang J, Hur H, Min BS, Lee KY, Kim NK. Cost-effectiveness of robotic surgery for rectal cancer focusing on short-term outcomes: a propensity score-matching analysis. Medicine (Baltimore) 2015; 94:e823. [PMID: 26039115 PMCID: PMC4616367 DOI: 10.1097/md.0000000000000823] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Although the total cost of robotic surgery (RS) is known to be higher than that of laparoscopic surgery (LS), the cost-effectiveness of RS has not yet been verified. The aim of the study is to clarify the cost-effectiveness of RS compared with LS for rectal cancer.From January 2007 through December 2011, 311 and 560 patients underwent totally RS and conventional LS for rectal cancer, respectively. A propensity score-matching analysis was performed with a ratio of 1:1 to reduce the possibility of selection bias. Costs and perioperative short-term outcomes in both the groups were compared. Additional costs due to readmission were also analyzed.The characteristics of the patients were not different between the 2 groups. Most perioperative outcomes were not different between the groups except for the operation time. Complications within 30 days of surgery were not significantly different. Total hospital charges and patients' bill were higher in RS than in LS. The total hospital charges for patients who recovered with or without complications were higher in RS than in LS, although their short-term outcomes were similar. In patients with complications, the postoperative course after RS appeared to be milder than that of LS. Total hospital charges for patients who were readmitted due to complications were similar between the groups.RS showed similar short-term outcomes with higher costs than LS. Therefore, cost-effectiveness focusing on short-term perioperative outcomes of RS was not demonstrated.
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Affiliation(s)
- Chang Woo Kim
- Division of Colon and Rectal Surgery (CWK, SHB, JK, HH, BSM, KYL, NKK), Department of Surgery, Severance Hospital; and Biostatistics Collaboration Unit (YHR), Yonsei University College of Medicine, Seoul, South Korea
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Lott FM, Favorito LA. Is previous experience in laparoscopic necessary to perform robotic radical prostatectomy? A comparative study with robotic and the classic open procedure in patients with prostate cancer. Acta Cir Bras 2015; 30:229-34. [DOI: 10.1590/s0102-8650201500300000011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 02/18/2015] [Indexed: 11/22/2022] Open
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69
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Independent predictors of prolonged operative time during robotic-assisted radical prostatectomy. J Robot Surg 2015; 9:117-23. [DOI: 10.1007/s11701-015-0497-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 01/16/2015] [Indexed: 12/20/2022]
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Abstract
Surgical robotic use has grown exponentially in spite of limited or uncertain benefits and large costs. In certain situations, adoption of robotic technology provides value to patients and society. In other cases, however, the robot provides little or no increase in surgical quality, with increased expense, and, therefore, does not add value to health care. The surgical robot is expensive to purchase, maintain and operate, and can contribute to increased consumerism in relation to surgical procedures, and increased reliance on the technology, thus driving future increases in health-care expenditure. Given the current need for budget constraints, the cost-effectiveness of specific procedures must be evaluated. The surgical robot should be used when cost-effective, but traditional open and laparoscopic techniques also need to be continually fostered.
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Kates M, Ball MW, Patel HD, Gorin MA, Pierorazio PM, Allaf ME. The financial impact of robotic technology for partial and radical nephrectomy. J Endourol 2014; 29:317-22. [PMID: 25167378 DOI: 10.1089/end.2014.0559] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE We sought to evaluate the financial impact of robotic technology for partial nephrectomy (PN) and radical nephrectomy (RN) in the state of Maryland. METHODS The Maryland Health Services Cost Review Commission (HSCRC) documents all acute care hospital charges data. This database was queried for patients who underwent laparoscopic or robot-assisted RN and PN from 2008 to 2012. Total hospital charge, subcharge, and length of stay (LOS) were analyzed separately for RN and PN. RESULTS Overall, 2834 patients were identified. Of those, 282 were laparoscopic PN (LPN), 1078 robot-assisted PN (RPN), 1098 laparoscopic RN (LRN), and 376 robot-assisted RN (RRN). For PN, the total hospital charge was $19,062 for LPN and $18,255 for RPN (P=0.138), with a charge savings of $807 per case in favor of robotics. For RN, the total hospital charge was $23,391 for RRN and $18,280 for LRN (P=0.004), with a charge premium of $5111 for robotic cases. LOS was shorter for RPN compared with LPN (2.51 vs 2.99 days, P<0.0001) and for RRN compared with LRN (3.52 vs 3.98, P=0.0498). CONCLUSIONS RPN is associated with lower hospital charges than LPN, while RRN is associated with higher hospital charges than LRN. Savings for RPN are driven by decreased room and board charge, while the premium for RRN is driven by higher operating room and supply charges. Because RRN use is increasing, the financial implications of RRN use for routine cases warrants further study.
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Affiliation(s)
- Max Kates
- The James Buchanan Brady Urological Institute and Department of Urology, The Johns Hopkins School of Medicine , Baltimore, Maryland
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72
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De Carlo F, Celestino F, Verri C, Masedu F, Liberati E, Di Stasi SM. Retropubic, laparoscopic, and robot-assisted radical prostatectomy: surgical, oncological, and functional outcomes: a systematic review. Urol Int 2014; 93:373-83. [PMID: 25277444 DOI: 10.1159/000366008] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 07/17/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Despite the wide diffusion of minimally invasive approaches, such as laparoscopic (LRP) and robot-assisted radical prostatectomy (RALP), few studies compare the results of these techniques with the retropubic radical prostatectomy (RRP) approach. The aim of this study is to compare the surgical, functional, and oncological outcomes and cost-effectiveness of RRP, LRP, and RALP. METHODS A systematic review of the literature was performed in the PubMed and Embase databases in December 2013. A 'free-text' protocol using the term 'radical prostatectomy' was applied. A total of 16,085 records were found. The authors reviewed the records to identify comparative studies to include in the review. RESULTS 44 comparative studies were identified. With regard to the perioperative outcome, LRP and RALP were more time-consuming than RRP, but blood loss, transfusion rates, catheterisation time, hospitalisation duration, and complication rates were the most optimal in the laparoscopic approaches. With regard to the functional and oncological results, RALP was found to have the best outcomes. CONCLUSION Our study confirmed the well-known perioperative advantage of minimally invasive techniques; however, available data were not sufficient to prove the superiority of any surgical approach in terms of functional and oncologic outcomes. On the contrary, cost comparison clearly supports RRP.
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Affiliation(s)
- Francesco De Carlo
- Department of Experimental Medicine and Surgery, Tor Vergata University, Rome, Italy
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Gandaglia G, Trinh QD. Models of assessment of comparative outcomes of robot-assisted surgery: best evidence regarding the superiority or inferiority of robot-assisted radical prostatectomy. Urol Clin North Am 2014; 41:597-606. [PMID: 25306171 DOI: 10.1016/j.ucl.2014.07.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The widespread dissemination of robot-assisted radical prostatectomy (RARP) occurred despite the absence of high-level evidence supporting its safety and efficacy in patients with clinically localized prostate cancer. This study aims at systematically evaluating the models adopted in scientific reports assessing the comparative effectiveness of RARP versus open radical prostatectomy (ORP). Although several retrospective observational studies have assessed the comparative effectiveness of RARP and ORP, currently no published randomized data are available to comprehensively evaluate this issue. Furthermore, well-designed prospective investigations are needed to ultimately assess the benefits of RARP compared with other treatment modalities in patients with clinically localized prostate cancer.
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Affiliation(s)
- Giorgio Gandaglia
- Division of Oncology, Unit of Urology, Urological Research Institute, San Raffaele Scientific Institute, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Via Olgettina 57, Milan 20132, Italy.
| | - Quoc-Dien Trinh
- Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, 45 Francis St, ASB II-3, Boston, MA 02115, USA
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Abrishami P, Boer A, Horstman K. Understanding the adoption dynamics of medical innovations: affordances of the da Vinci robot in the Netherlands. Soc Sci Med 2014; 117:125-33. [PMID: 25063968 DOI: 10.1016/j.socscimed.2014.07.046] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 07/15/2014] [Accepted: 07/17/2014] [Indexed: 01/21/2023]
Abstract
This study explored the rather rapid adoption of a new surgical device - the da Vinci robot - in the Netherlands despite the high costs and its controversial clinical benefits. We used the concept 'affordances' as a conceptual-analytic tool to refer to the perceived promises, symbolic meanings, and utility values of an innovation constructed in the wider social context of use. This concept helps us empirically understand robot adoption. Data from 28 in-depth interviews with diverse purposively-sampled stakeholders, and from medical literature, policy documents, Health Technology Assessment reports, congress websites and patients' weblogs/forums between April 2009 and February 2014 were systematically analysed from the perspective of affordances. We distinguished five interrelated affordances of the robot that accounted for shaping and fulfilling its rapid adoption: 'characteristics-related' affordances such as smart nomenclature and novelty, symbolising high-tech clinical excellence; 'research-related' affordances offering medical-technical scientific excellence; 'entrepreneurship-related' affordances for performing better-than-the-competition; 'policy-related' affordances indicating the robot's liberalised provision and its reduced financial risks; and 'communication-related' affordances of the robot in shaping patients' choices and the public's expectations by resonating promising discourses while pushing uncertainties into the background. These affordances make the take-up and use of the da Vinci robot sound perfectly rational and inevitable. This Dutch case study demonstrates the fruitfulness of the affordances approach to empirically capturing the contextual dynamics of technology adoption in health care: exploring in-depth actors' interaction with the technology while considering the interpretative spaces created in situations of use. This approach can best elicit real-life value of innovations, values as defined through the eyes of (potential) users.
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Affiliation(s)
- Payam Abrishami
- Research School CAPHRI, Department of Health, Ethics and Society, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands; National Health Care Institute, P.O. Box 320, 1110 AH Diemen, The Netherlands.
| | - Albert Boer
- National Health Care Institute, P.O. Box 320, 1110 AH Diemen, The Netherlands; Institute of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands.
| | - Klasien Horstman
- Research School CAPHRI, Department of Health, Ethics and Society, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
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Gandaglia G, Suardi N, Gallina A, Zaffuto E, Cucchiara V, Vizziello D, Shariat S, Cantiello F, Damiano R, Guazzoni G, Montorsi F, Briganti A. How to Optimize Patient Selection for Robot-Assisted Radical Prostatectomy: Functional Outcome Analyses from a Tertiary Referral Center. J Endourol 2014; 28:792-800. [DOI: 10.1089/end.2014.0007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Giorgio Gandaglia
- Urological Research Institute, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy
| | - Nazareno Suardi
- Urological Research Institute, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Gallina
- Urological Research Institute, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy
| | - Emanuele Zaffuto
- Urological Research Institute, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy
| | - Vito Cucchiara
- Urological Research Institute, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy
| | - Damiano Vizziello
- Urological Research Institute, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy
| | - Shahrokh Shariat
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Francesco Cantiello
- Department of Urology and Doctorate Research Program, Magna Græcia University of Catanzaro, Catanzaro, Italy
| | - Rocco Damiano
- Department of Urology and Doctorate Research Program, Magna Græcia University of Catanzaro, Catanzaro, Italy
| | - Giorgio Guazzoni
- Urological Research Institute, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Montorsi
- Urological Research Institute, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Briganti
- Urological Research Institute, Vita-Salute San Raffaele University, San Raffaele Scientific Institute, Milan, Italy
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Byrd JK, Smith KJ, de Almeida JR, Albergotti WG, Davis KS, Kim SW, Johnson JT, Ferris RL, Duvvuri U. Transoral Robotic Surgery and the Unknown Primary: A Cost-Effectiveness Analysis. Otolaryngol Head Neck Surg 2014; 150:976-82. [PMID: 24618502 PMCID: PMC4167971 DOI: 10.1177/0194599814525746] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 02/06/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the cost-effectiveness of transoral robotic surgery (TORS) for the diagnosis and treatment of cervical unknown primary squamous cell carcinoma (CUP). STUDY DESIGN Case series with chart review. SETTING Tertiary academic hospital. SUBJECTS AND METHODS A retrospective chart review was performed on patients with new occult primary squamous cell carcinoma of the head and neck with nondiagnostic imaging and/or endoscopy who were treated with TORS at a tertiary hospital between 2009 and 2012. Direct costs were obtained from the hospital's billing system, and national data were used for inpatient hospital costs and physician fees. The proportion of tumors found in 3 strategies was used as effectiveness to calculate the incremental cost-effectiveness ratio. RESULTS In total, 206 head and neck robotic cases were performed at our institution between December 2009 and December 2012. Three surgeons performed TORS on 22 patients for occult primary squamous cell carcinoma. The primary tumor was located in 19 of 22 patients (86.4%). The incremental cost-effectiveness ratio for sequential and simultaneous examination under anesthesia with tonsillectomy (EUA) and TORS base of tongue resection was $8619 and $5774 per additional primary identified, respectively. CONCLUSION Sequential EUA followed by TORS is associated with an incremental cost-effectiveness ratio of $8619 compared with traditional EUA alone. Bilateral base of tongue resection should be considered in the workup of these patients, particularly if the palatine tonsils have already been removed.
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Affiliation(s)
- J Kenneth Byrd
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Kenneth J Smith
- Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - John R de Almeida
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - W Greer Albergotti
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Kara S Davis
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Seungwon W Kim
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jonas T Johnson
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Robert L Ferris
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Umamaheswar Duvvuri
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA VA Pittsburgh Health System, Pittsburgh, Pennsylvania, USA
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Gandaglia G, Sammon JD, Chang SL, Choueiri TK, Hu JC, Karakiewicz PI, Kibel AS, Kim SP, Konijeti R, Montorsi F, Nguyen PL, Sukumar S, Menon M, Sun M, Trinh QD. Comparative effectiveness of robot-assisted and open radical prostatectomy in the postdissemination era. J Clin Oncol 2014; 32:1419-26. [PMID: 24733797 DOI: 10.1200/jco.2013.53.5096] [Citation(s) in RCA: 145] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Given the lack of randomized trials comparing robot-assisted radical prostatectomy (RARP) and open radical prostatectomy (ORP), we sought to re-examine the outcomes of these techniques using a cohort of patients treated in the postdissemination era. PATIENTS AND METHODS Overall, data from 5,915 patients with prostate cancer treated with RARP or ORP within the SEER-Medicare linked database diagnosed between October 2008 and December 2009 were abstracted. Postoperative complications, blood transfusions, prolonged length of stay (pLOS), readmission, additional cancer therapies, and costs of care within the first year after surgery were compared between the two surgical approaches. To decrease the effect of unmeasured confounders, instrumental variable analysis was performed. Multivariable logistic regression analyses were then performed. RESULTS Overall, 2,439 patients (41.2%) and 3,476 patients (58.8%) underwent ORP and RARP, respectively. In multivariable analyses, patients undergoing RARP had similar odds of overall complications, readmission, and additional cancer therapies compared with patients undergoing ORP. However, RARP was associated with a higher probability of experiencing 30- and 90-day genitourinary and miscellaneous medical complications (all P ≤ .02). Additionally, RARP led to a lower risk of experiencing blood transfusion and of having a pLOS (all P < .001). Finally, first-year reimbursements were greater for patients undergoing RARP compared with ORP (P < .001). CONCLUSION RARP and ORP have comparable rates of complications and additional cancer therapies, even in the postdissemination era. Although RARP was associated with lower risk of blood transfusions and a slightly shorter length of stay, these benefits do not translate to a decrease in expenditures.
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Affiliation(s)
- Giorgio Gandaglia
- Giorgio Gandaglia, Pierre I. Karakiewicz, and Maxine Sun, Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Giorgio Gandaglia and Francesco Montorsi, Urological Research Institute, Vita-Salute San Raffaele University, Milan, Italy; Jesse D. Sammon and Mani Menon, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI; Steven L. Chang, Toni K. Choueiri, Adam S. Kibel, Ramdev Konijeti, Paul L. Nguyen, and Quoc-Dien Trinh, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Jim C. Hu, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA; Simon P. Kim, Yale University, New Haven, CT; and Shyam Sukumar, University of Minnesota, Minneapolis, MN
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[Prostate brachytherapy: oncological and functional results after 400 cases]. Urologia 2014; 81 Suppl 23:S15-9. [PMID: 24665030 DOI: 10.5301/ru.2014.11980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2013] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Brachytherapy (BT) with real-time technique for the treatment of low and medium risk prostate cancer (CaP) has been a well known practice for over 25 years in the USA and for over
15 years in Italy. However, it is an uncommon procedure, because of problems related to the organization and cooperation among urologists, radiotherapists and physics, to the competition of alternative therapies, to dogmatic and educational beliefs, and to the poor knowledge of this technique.
METHODS Between May1999 and July 2013, 400 patients with low and medium risk CaP underwent I 125 BT using a "real-time" approach. The seeds implantation was performed using a Mick applicator in the first 190 patients and the "QuickLink" technique in the last 210 cases. Oncologic results were reported for the first 250 cases with a mean follow-up of 10 years, while functional outcomes and complications were assessed in 350 patients with a minimum follow-up of 1 year.
RESULTS A good quality implantation was assessed in 90% of the patients (D90>145 Gy). A biochemical failure was assessed, based on Phoenix criteria, in 12 patients (4.8%). Out of these patients,
10 underwent prostate biopsy (the other 2 patients showed a systemic disease). The biopsy showed a CaP in 6/10 patients who underwent retropubic radical prostatectomy (4 patients) and external radiotherapy (2 patients) respectively. The remaining 4/10 patients with negative biopsy were treated with total androgen blockade (3 patients) and watchful waiting (1 patient) respectively. Functional results showed an incidence of postoperative irritative disorders in 70% of the patients during the first six months and a good recovery of erectile function in 78.8% and 68.2% of the patients after one and five years from BT respectively.
CONCLUSION Brachytherapy is a good alternative to radical prostatectomy in the low and medium risk prostatic cancers with excellent oncologic and functional results.
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Gardiner RA, Coughlin GD, Yaxley JW, Dunglison NT, Occhipinti S, Younie SJ, Carter RC, Williams SG, Medcraft RJ, Samaratunga HM, Perry-Keene JL, Payton DJ, Lavin MF, Chambers SK. A Progress Report on a Prospective Randomised Trial of Open and Robotic Prostatectomy. Eur Urol 2014; 65:512-5. [DOI: 10.1016/j.eururo.2013.10.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 10/21/2013] [Indexed: 10/26/2022]
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Philippou Y, Hadjipavlou M, Khan S, Ahmed K, Rane A. Localised prostate cancer: clinical and cost-effectiveness of new and emerging technologies. JOURNAL OF CLINICAL UROLOGY 2014. [DOI: 10.1177/2051415813519628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In contrast to pharmacological interventions that undergo rigorous clinical testing, recent technological advances in the treatment of prostate cancer (PCa) have particularly been introduced and driven by economic incentives rather than high-quality clinical evidence. In this review we summarise the clinical and cost-effectiveness of new and emerging technologies for localised PCa. We emphasise particularly on robotic prostatectomy, new developments in radiotherapy, novel technologies in focal therapy such as cryosurgery and high-intensity focused ultrasound (HIFU). Robotic-assisted laparoscopic radical prostatectomy (RALRP) has similar oncologic outcomes to open radical retropubic prostatectomy (RRP); however, patients who undergo RALRP are more likely to have improved short-term potency rates. Intensity-modulated radiotherapy (IMRT) and proton-beam therapy (PBT) have similar oncologic outcomes to external-beam radiotherapy (EBRT). IMRT has exhibited an improved gastrointestinal side effect profile compared to EBRT. PBT is not cost-effective compared to other radiotherapy modalities. Early studies of focal therapies in localised PCa have yielded positive results. Treatment decisions should be driven by cancer risk and patient preference rather than by financial incentives or availability of technology.
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Affiliation(s)
| | | | - Shahid Khan
- Department of Urology, East Surrey Hospital, UK
| | - Kamran Ahmed
- MRC Centre for Transplantation, King’s College London; Department Of Urology, Guy’s Hospital, UK
| | - Abhay Rane
- Department of Urology, East Surrey Hospital, UK
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Abstract
BACKGROUND AND OBJECTIVES Computer-assisted robotic surgery allows complex resections and anastomotic reconstructions to be performed with nearly identical standards to open surgery. We applied this technology to a variety of pancreatic resections to assess the safety, feasibility, versatility, and reliability of this technology. METHODS A retrospective review of a prospective database of robotic pancreatic resections at a single institution between August 2008 and November 2012 was performed. Perioperative outcomes were analyzed. RESULTS A total of 250 consecutive robotic pancreatic resections were analyzed; pancreaticoduodenectomy (132), distal pancreatectomy (83), central pancreatectomy (13), pancreatic enucleation (10), total pancreatectomy (5), Appleby resection (4), and Frey procedure (3). Thirty-day and 90-day mortality was 0.8% and 2.0%. Rate of Clavien 3 and 4 complications was 14% and 6%. The International Study Group on Pancreatic Fistula grade C fistula rate was 4%. Mean operative time for the 2 most common procedures was 529 ± 103 minutes for pancreaticoduodenectomy and 257 ± 93 minutes for distal pancreatectomy. Continuous improvement in operative times was observed over the course of the experience. Conversion to open procedure was required in 16 patients (6%) (11 with pancreaticoduodenectomy, 2 with distal pancreatectomy, 2 with central pancreatectomy, 1 with total pancreatectomy) for failure to progress (14) and bleeding (2). CONCLUSIONS This represents to our knowledge the largest series of robotic pancreatic resections. Safety and feasibility metrics including the low incidence of conversion support the robustness of this platform and suggest no unanticipated risks inherent to this new technology. By defining these early outcome metrics, this report begins to establish a framework for comparative effectiveness studies of this platform.
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The end of robot-assisted laparoscopy? A critical appraisal of scientific evidence on the use of robot-assisted laparoscopic surgery. Surg Endosc 2013; 28:1388-98. [DOI: 10.1007/s00464-013-3306-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 10/19/2013] [Indexed: 12/15/2022]
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83
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Modeling Costs for Prostate Surgery: Are We Close to Reality? Eur Urol 2013; 64:370-1. [DOI: 10.1016/j.eururo.2013.05.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 05/20/2013] [Indexed: 11/20/2022]
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