Robotic versus laparoscopic adrenalectomy: a patient-level costing study using the NHS Patient-Level Information and Costing System

Abstract

Background: The UK government plans to have 90% of minimally invasive surgery performed using a robotic approach by 2035. Within a taxpayer funded health system, there is need to ensure new technologies are cost effective. The aim of this study is to perform a cost analysis comparing robotic adrenalectomy (RA) to laparoscopic adrenalectomy (LA)   
Methods: Consecutive minimally invasive adrenalectomies were retrospectively analysed over a 1-year period and were subdivided into laparoscopic and robotic groups. Patient demographics, tumour size, indication, length of stay, operative time and intra-operative complications were recorded. Using patient level information and costing system (PLICS), the total costs of each patient was recorded against the income (tariff) generated. The costs and income generated from robotic adrenalectomies were compared to the laparoscopic group. 

 
Results: 62 patients were included, 32 (laparoscopic) vs 30 (robotic). Patients in the RA group were significantly younger (52.2 vs. 60.1 years, p <0.05) and had higher BMI (32.7 vs. 28.3 kg/m², p <0.05). LOS was significantly shorter in the RA group (1 vs. 2 days, p <0.05). There was no significant difference in average tariff for both groups (£6,822 (RA) vs £6,585 (LA), p=0.46). RA was associated with significantly lower overall costs (£4,945 vs. £6,027, p <0.05). Average net surplus was higher in the RA group compared to the LA group (£1,640 vs. £795, p=0.07).  After adjusting for the cost of the consumables, (£1,160(RA) vs £518(LA)), the net surplus remained higher in the RA group (£480 vs £277).  

Conclusion: Overall costs for patients undergoing robotic adrenalectomy was significantly lower compared to laparoscopic adrenalectomy. This can be explained by reduction in the length of stay, and theatre costs. These findings suggest that robotic adrenalectomy can be offered as the standard of care for patients at no additional costs with better outcomes compared to laparoscopic adrenalectomy.