720 860
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
Prasad (2011)
[76]1548 MIRP
5565 RRP
Retrospective
cohort study
SEER-Medicare 2002–
2005
MIRP
versus RRP
1. Total Medicare
payments from day of
surgery through 6 mo
thereafter
2. Prostate cancer-
related Medicare
payments from day of
surgery through 6 mo
thereafter
Medicare payments
Payer
Mean MIRP cost: $14 939
Mean RRP cost: $14 301
Difference: $638
(no adjustment for inflation done, statistically
significant difference)
Limiting to claims with prostate cancer
diagnosis code:
Mean MIRP cost: $12 289
Mean RRP cost: $11 884
Difference: $405
Risk of bias is high. No adjusted models were
constructed for the cost estimation.
Additionally, Medicare reimbursement varies
by many intentional factors other than type of
treatment, including, for example, price
differences based on regional wage disparities,
cost of living, illness severity, and the expense
of caring for underinsured patients
[16] .Lowrance (2012)
[77]
991 MIRP
4454 RRP
Retrospective
cohort study
SEER-Medicare 2003–
2005
MIRP
versus RRP
Medicare payments
for all claims during
the year after day of
hospital admission for
prostatectomy
Medicare payments
Payer
Mean MIRP cost: $16 919 (2006)
Mean RRP cost: $15 692 (2006)
Difference: $1227 (2006)
Difference not statistically significant.
In adjusted analyses, MIRP cost was
approximately 2% greater, but difference was
not statistically significant.
Risk of bias moderate as residual confounding
may have been present.
Additionally, Medicare reimbursement varies
by many intentional factors other than type of
treatment, including, for example, price
differences based on regional wage disparities,
cost of living, illness severity, and the expense
of caring for underinsured patients
[16] .Shih (2012)
[31]
3144 MIRP
7525 RRP
Retrospective
cohort study
IMS LifeLink Health
Plan Claims Database
2003–2007 (managed
care plan enrollees)
MIRP
versus RRP
Payments allowed by
the health plan
(amount paid by the
health plan plus
patient copay) within
the first 6 mo after
surgery
Health plan payments Payer
Mean MIRP cost: $22 837 (2010)
Mean RRP cost: $21 914 (2010)
Difference: $923 (2010)
Adjusted 6 mo cost difference was $8 (95% CI –
952 to 969).
Risk of bias is moderate, as residual
confounding may have been present.
Hofer (2013)
[78]23 473 MIRP
118 266 RRP
Retrospective
cohort study
Nationwide Inpatient
Sample 2002–2008
MIRP
versus RRP
Charges directly
examined
Only charges
measured
Payer
MIRP mean charge: $34 000 (2008)
RRP mean charge: $32 000 (2008)
Difference: $2000 (2008)
Charges are unlikely to be meaningful because
hospitals can freely set charge master rates.
While most markups fall into the 1.5–4 range
relative to Medicare allowable cost, the
markup may be more than 10 times that cost
[19]
.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
720