دورية أكاديمية
Robot-assisted surgery in a broader healthcare perspective: a difference-in-difference-based cost analysis of a national prostatectomy cohort.
| العنوان: | Robot-assisted surgery in a broader healthcare perspective: a difference-in-difference-based cost analysis of a national prostatectomy cohort. |
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| المؤلفون: | Hyldgård VB; Health Economics, DEFACTUM, Central Denmark Region, Aarhus, Denmark.; Department of Public Health, Aarhus University, Aarhus, Denmark., Laursen KR; Department of Public Health, Aarhus University, Aarhus, Denmark., Poulsen J; Department of Urology, Aalborg University Hospital, Aalborg, Denmark.; Department of Urology, King's College Hospital, London, UK., Søgaard R; Department of Public Health, Aarhus University, Aarhus, Denmark.; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark. |
| المصدر: | BMJ open [BMJ Open] 2017 Jul 21; Vol. 7 (7), pp. e015580. Date of Electronic Publication: 2017 Jul 21. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: BMJ Publishing Group Ltd Country of Publication: England NLM ID: 101552874 Publication Model: Electronic Cited Medium: Internet ISSN: 2044-6055 (Electronic) Linking ISSN: 20446055 NLM ISO Abbreviation: BMJ Open Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: [London] : BMJ Publishing Group Ltd, 2011- |
| مواضيع طبية MeSH: | Health Care Costs*, Delivery of Health Care/*economics , Health Services/*economics , Laparoscopy/*economics , Prostatectomy/*economics , Prostatic Neoplasms/*surgery , Robotics/*economics, Aged ; Cohort Studies ; Costs and Cost Analysis ; Denmark ; Hospital Costs ; Hospitalization ; Humans ; Laparoscopy/methods ; Male ; Middle Aged ; Prostatectomy/methods ; Robotics/methods |
| مستخلص: | Objective: To estimate costs attributable to robot-assisted laparoscopic prostatectomy (RALP) as compared with open prostatectomy (OP) and laparoscopic prostatectomies (LP) in a National Health Service perspective. Patients and Methods: Register-based cohort study of 4309 consecutive patients who underwent prostatectomy from 2006 to 2013 (2241 RALP, 1818 OP and 250 LP). Patients were followed from 12 months before to 12 months after prostatectomy with respect to service use in primary care (general practitioners, therapists, specialists etc) and hospitals (inpatient and outpatient activity related to prostatectomy and comorbidity). Tariffs of the activity-based remuneration system for primary care and the Diagnosis-Related Grouping case-mix system for hospital-based care were used to value service use. Costs attributable to RALP were estimated using a difference-in-difference analytical approach and adjusted for patient-level and hospital-level risk selection using multilevel regression. Results: No significant effect of RALP on resource-use was observed except for a marginally lower use of primary care and fewer bed days as compared with OP (not LP). The overall cost consequence of RALP was estimated at an additional €2459 (95% CI 1377 to 3540, p=0.003) as compared with OP and an additional €3860 (95% CI 559 to 7160, p=0.031) as compared with LP, mainly due to higher cost intensity during the index admissions. Conclusions: In this study from the Danish context, the use of RALP generates a factor 1.3 additional cost when compared with OP and a factor 1.6 additional cost when compared with LP, on average, based on 12 months follow-up. The policy interpretation is that the use of robots for prostatectomy should be driven by clinical superiority and that formal effectiveness analysis is required to determine whether the current and eventual new purchasing of robot capacity is best used for prostatectomy. Competing Interests: Competing interests: None declared. (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.) |
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| فهرسة مساهمة: | Keywords: cost analysis; economics; prostate cancer; prostatectomy; robot-assisted surgery; robotics and laparoscopy |
| تواريخ الأحداث: | Date Created: 20170723 Date Completed: 20180427 Latest Revision: 20190202 |
| رمز التحديث: | 20221213 |
| مُعرف محوري في PubMed: | PMC5642660 |
| DOI: | 10.1136/bmjopen-2016-015580 |
| PMID: | 28733299 |
| قاعدة البيانات: | MEDLINE |
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