An Assessment of Comparative Marginal Costs to Non-Robotic Surgery for Radical Prostatectomy amongst Public Patients

Objective: Surgical procedures assisted by robotic technology have been increasing in uptake, particularly in private hospitals. Unlike most of the studies on robotic technology which were sponsored by pecuniary interests of the dominant Monopoly supplier, this paper is an independent investigators’ initiated study of comparative health system costs in a Local Health District on Robotic Surgery (RS) versus Non-RS for patients undergoing prostatectomy amongst a cohort of public patients. The report was limited to understanding the cost implications of RS and productivity savings associated with it via consistently reduced length of stay (LOS). Patient benefits were not formally measured or assessed. Methods: Estimated marginal costs of both RS and Non-RS were ascertained via cost modelling Activity Based Funding (ABF) cost bucket categories for each inpatient separation for Non-RS radical prostatectomy and comparing these to actual costs for patients undergoing RS for radical prostatectomy. This approach compared the expected non-theatre costs of both RS and Non-RS, and considered appropriate cost bucket comparators for operating theatre costs. Results: The results are in congruence with established literature, RS costs are higher than Non-RS. Specifically, this study found that RS yielded a productivity saving to the health system of two days shorter LOS, than Non-RS. However, the marginal cost per separation of RS prostatectomy is $3086 higher than Non-RS prostatectomy in the instruments and consumables costs. Any potential savings associated with reduced LOS do not offset the higher marginal costs associated with RS. Conclusion: Instruments and consumables for RS remain as monopoly products, save for competitive forces; the health system costs for RS are likely to remain significantly higher than non-RS.