718 860
Table 1 (
Continued
)
Study
Patients, no.
Type of
study
Data source
Comparison Cost definition
Costs included
(direct vs indirect)
Perspective
Main findings
including comment
on risk of bias
Fabbro (2014)
[71]53 RARP
50 RRP
Retrospective
cohort study
Institutional data
2009–2010
RARP
versus RRP
Costs were based on
the use of consumable
equipment, surgical
and anesthesia
equipment, staff,
transfusions using
internal hospital data
Direct and indirect
costs were included,
including purchase
cost, amortization, and
maintenance of robot
Hospital
RARP cost:
s
11 272
RRP cost:
s
4834
Difference:
s
6438
Risk of bias is high, because no adjustments for
patient characteristics were made and the
number of patients included is low.
Faiena (2015)
[72]
24 636 RARP
13 590 RRP
Retrospective
cohort study
Nationwide Inpatient
Sample 2009–2011
RARP
versus RRP
Charge data and cost-
to-charge ratios
Only charges
measured
Hospital
RARP was more expensive than RRP in all
regions of the USA except for the northeast.
This persisted after adjusting for patient
characteristics.
Risk of bias moderate, because charges are
unlikely to reflect true cost.
Yanamadala (2016)
[73]
28 301 RARP
8393 open RP
Retrospective
cohort study
HCUP State Inpatient
and Amubulatory
Surgery Databases for
CA, FL, NY 2009–2011
RARP versus
open RP
Cost calculated by
applying cost-to-
charge ratios
Only charges
measured
Hospital
Mean RARP cost: $13 615 (2011)
Mean open RP cost: $12 167 (2011)
Difference: $1448 (2011)
Risk of bias high, because cost not adjusted for
patient-level differences and charges are
unlikely to reflect true cost.
Leow (2016)
[23]311 135 RARP
318 458 RRP
(weighted
sample)
Retrospective
cohort study
Premier Hospital
Database 2003–2013
RARP
versus RRP
90-d direct hospital
costs
Direct costs only
Hospital
Adjusted 90-d RARP cost: $14 897 (2014)
Adjusted 90-d RRP cost: $9558 (2014)
Difference: $4528 (2014)
Cost difference not significant among the
highest-volume surgeons ( 2 cases/wk).
Risk of bias moderate as residual confounding
may be present.
Basto (2016)
[24]
2646 MIRP
2702 RRP
Cost modeling Victorian Admitted
Episode Dataset 2010–
2013
MIRP
versus RRP
Costs modeled based
on DRG, LOS, indirect
costs, blood
transfusion costs
Direct and indirect
costs, including
purchase cost and
maintenance of robot
Hospital
Incremental cost of RARP when LOS and blood
transfusion cost offset was applied: A$3548
(2013) for da Vinci SI dual model.
Cost neutrality reached with 200 RPs per
year.
Risk of bias high because patient factors were
not accounted for.
Gagnon (2014)
[74]
200 RARP
200 RRP
Retrospective
cohort study
Institutional data
Years from which data
were pulled are not
provided
RARP
versus RRP
Cost estimation
including additional
OR time, disposable
supply, depreciation,
and service contracts.
No additional details
given on how this was
calculated
Direct and indirect
costs, including
amortization and
maintenance cost of
robot
Hospital
Added cost of CAN$5629 per case for RARP.
Risk of bias is high as no details on cost
calculation are given in the manuscript. It does
not appear as if cost was adjusted for patient
characteristics.
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
718