717 860
Kim (2013)
[65]
20 424 RARP
9413 open RP
Retrospective
cohort study
Nationwide Inpatient
Sample and American
Hospital Association
Annual Survey 2006–
2008
RARP versus
open RP
Costs estimated based
on cost-to-charge ratio
Direct and indirect
costs
Hospital
Median RARP cost: $10 409 (2008)
Median open RP cost: $8862 (2008)
Adjusted costs $2142 (2008) were higher for
RARP than for open RP (adjusted for age, race,
comorbidity, insurance, income by zip code,
year of surgery, hospital teaching status,
location, region, and case volume).
Risk of bias moderate as residual confounding
may be present and cost-to-charge ratios do
not completely reflect true cost.
Yu (2012)
[66]11 513 RARP
9704 open RP
(weighted
sample sizes)
Retrospective
cohort study
Nationwide Inpatient
Sample 2008
RARP versus
open RP
Cost calculated by
applying cost-to-
charge ratios
Only charges
measured
Hospital
Median adjusted RARP cost: $10 804 (2008)
Median adjusted open RP cost: $9 693 (2008)
Difference: $1111 (2008)
Cost adjusted for measured patient and
hospital characteristics.
Risk of bias moderate as unmeasured
confounding may have been present and
charges are unlikely to reflect true cost.
Hall (2014)
[67]
100 RARP
100 RRP
Retrospective
cohort study
Institutional data
2007–2009
RARP
versus RRP
Institutional costing
reports
Probably direct and
indirect costs, but not
clearly described (cost
of robot and
maintenance likely not
included)
Hospital
RARP mean cost: A$17 582 (2008)
RRP mean cost: A$13 605 (2008)
Difference: A$3977 (2008)
Generalizability is limited outside of Royal
Brisbane Hospital.
Risk of bias high because costs were not
adjusted for patient characteristics and the
number of patients included is low.
Tomaszewski (2012)
[68]115 RARP
358 RRP
Retrospective
cohort study
Institutional data
2009–2010
RARP
versus RRP
Cost accounting from
the hospital finance
department
Direct and indirect
costs including
purchase and
maintenance costs of
the robot
Hospital
Mean RARP cost: $14 006
Mean RRP cost: $8686
Difference: $5320
(no adjustment for inflation done, statistically
significant difference)
Risk of bias high as cost was not adjusted for
patient characteristics. Differences in patient
characteristics between RARP and RRP patients
were not reported.
Chang (2015)
[69]150 921 RARP
338 448
non-RARP
(weighted
sample)
Retrospective
cohort study
Premier Hospital
Database, USA 2003–
2010
RARP versus
non-RARP
90-d direct hospital
costs (unclear how
exactly they were
measured)
Direct costs
Hospital
RARP cost: $10 622 (2010)
Non-RARP cost: $8681 (2010)
Difference: $1941 (2010)
Risk of bias high because the above costs were
not adjusted for patient factors.
Chughtai (2015)
[70]
850 000 RPs,
breakdown of
RARP versus
RRP not given
Retrospective
cohort study
Nationwide Inpatient
Sample 2000–2011
MIRP
versus RRP
Charge data and cost-
to-charge ratios
Only charges
measured
Hospital
Median MIRP cost: $11 145 (2010)
Median RRP cost: $8918 (2010)
Difference: $2227 (2010)
MIRP costs significantly higher than RRP costs
when adjusting for patient demographics,
comorbidities, LOS, and hospital characteristics
($ not given).
Risk of bias moderate, because charges are
unlikely to reflect true cost.
E U R O P E A N U R O L O G Y 7 2 ( 2 0 1 7 ) 7 1 2 – 7 3 5
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