Robotic surgeries are associated with lower out-of-pocket (OOP) costs and total payments than traditional procedures, according to new research published in JAMA Network Open.
“Although value-driven initiatives in the United States have traditionally emphasized eliminating excessive administrative costs and/or physician reimbursements, the role of innovative—and costly—technologies such as robotic surgery in increased health care spending has not been well studied, to our knowledge,” wrote lead author Junaid Nabi, MD, MPH, with Brigham and Women’s Hospital in Boston, and colleagues.
The team explored data from insurance claims for 1.9 million patients who received care from Jan. 1, 2012, to Dec. 31, 2017. The final dataset included more than 15,000 patients between the ages of 18 and 64. All patients underwent one of five cancer surgeries—radical prostatectomy (RP), hysterectomy (HYS), partial colectomy (PC), radical nephrectomy (RN) and partial nephrectomy (PN)—while enrolled in an employer-sponsored health insurance plan.
Overall, 8,260 patients underwent robotic procedures, and the remaining 7,633 patients underwent open procedures. Inverse probability of treatment weighting (IPTW) propensity score analyses revealed that OOP costs and total payments were lower for all five procedures when the robotic approach was used. IPTW-adjusted analyses also found that the robotic approach was associated with a shorter length of stay (LOS) for all five procedures.
“These results highlight the complexity of economic factors that are associated with the rapid adoption and possible subsidization of the robotic approach for common surgically amenable conditions and lay a foundation for future work on this issue,” the authors wrote.
Nabi et al. noted that their study did not account for “the costs of procuring and maintaining a robotic system.” Robotic surgery may also include additional costs related to the use of disposable instruments that will need to be regularly replaced.
“Our analyses indicate that the additional costs of robot acquisition and maintenance are seemingly not paid by private health insurers (approximated here by total payments) or patients (approximated here by OOP costs); if such is the case, by extension, these costs appear to be absorbed by the hospitals,” the authors wrote.
And why would hospitals take on these costs? It may be related to high net profits, according to the authors, and public demand is likely another key reason.
“Evidence supports the finding that direct-to-consumer advertising of robotic surgery increases demand,” they wrote. “This higher demand could influence hospitals offering robotic surgery as a viable option to retain market share and stay competitive. Our finding of significantly lower OOP costs associated with the robotic approach is likely to compound this trend.”
Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.