Cost analysis of robotic-assisted laparoscopic hysterectomy versus total abdominal hysterectomy for women with endometrial cancer and atypical complex hyperplasia

INTRODUCTION: The aim was to analyse the hospital cost of treatment with robotic-assisted laparoscopic hysterectomy (RALH) and total abdominal hysterectomy (TAH) for women with endometrial cancer or atypical complex hyperplasia and to identify differences in resource use and cost.

MATERIAL AND METHODS: This cost analysis was based on two cohorts: women treated with RALH or TAH at Copenhagen University Hospital, Herlev, Denmark. The study sample included 158 women treated by TAH and 202 women treated by RALH. We conducted an activity-based costing analysis including consumables and healthcare professionals' salaries. As cost-drivers we included severe complications, duration of surgery, anaesthesia and stay at the post-anaesthetic care unit as well as number of hospital bed-days. Ordinary least squares regression was used to explore the cost variation. The primary outcome was cost difference in Danish kroner (DKK) between TAH and RALH.

RESULTS: The average cost of consumables for RALH was 12 642 DKK more expensive per patient than for RALH. (2014 price level: 1€ =7.50 DKK.) When including all cost drivers the analysis showed that the RALH procedure was 9 386 DKK (17%) cheaper than the TAH (p=0.003). When the robot investment was included the cost difference reduced to 4 053 DKK (RALH was 7% cheaper than TAH) (p=0.20). Increasing age and Type 2 Diabetes appeared to influence the overall costs.

CONCLUSION: For women with endometrial cancer or atypical complex hyperplasia, RALH was cheaper compared to TAH, mostly due to fewer complications and shorter length of hospital stay. This article is protected by copyright. All rights reserved.