Prostatecomy using the daVinci robot not currently cost-effective

Use of the daVinci robot (Intuitive Surgical, Sunnyvale, CA) for radical prostatectomy procedures is not profitable, according to research presented here yesterday by a team at the University of Rochester Medical Center. However, the researchers say that the costs associated with robotic procedures must eventually come down because the technology is here to stay.

"The costs will come down because they have to because of market forces," said co-author Hitendra R.H. Patel, MD, PhD, director of laparoscopy and robotic surgery, Institute of Urology, University College, London. "Owning a robot is profitable for a hospital, but it's by indirect means. The publicity that it generates brings people to the hospital to have their vasectomies there."

"Hospitals with the robot need to assess their contractual agreement with third-party payers, because currently patients are demanding this technology. [The hospitals] are somewhat hostage to the technology," said presenter Jean Joseph, MD, MBA, head of laparoscopy and robotics in the University of Rochester's department of urology.

To evaluate costs, the team reviewed 174 robotic procedures performed at the University of Rochester Medical Center over a period of 18 months. Almost all of the procedures were prostatectomies (94%), while pyeloplasties accounted for 4% and cardiac valve repairs for the remaining 2%. The total hospital cost per radical prostatectomy was $9,102. Broken down, the fixed and variable costs per case totaled $2,949 and $6,153 respectively; average cost of reposables and disposables per case were $1,138 and $1,577 respectively. The initial cost of the robot approached $1 million, and all other costs including repair totaled $330,000 during the study.

Reimbursement per case averaged $8,954, which means each case resulted in a net loss for the hospital without even considering the initial cost and maintainence of the robot.