%0 Journal Article
%T The Feasibility of Societal Cost Equivalence between Robotic Hysterectomy and Alternate Hysterectomy Methods for Endometrial Cancer
%A Neel T. Shah
%A Kelly N. Wright
%A Gudrun M. Jonsdottir
%A Selena Jorgensen
%A Jon I. Einarsson
%A Michael G. Muto
%J Obstetrics and Gynecology International
%D 2011
%I Hindawi Publishing Corporation
%R 10.1155/2011/570464
%X Objectives. We assess whether it is feasible for robotic hysterectomy for endometrial cancer to be less expensive to society than traditional laparoscopic hysterectomy or abdominal hysterectomy. Methods. We performed a retrospective cohort analysis of patient characteristics, operative times, complications, and hospital charges from all ( ) endometrial cancer patients who underwent hysterectomy in 2009 at our hospital. Per patient costs of each hysterectomy method were examined from the societal perspective. Sensitivity analysis and Monte Carlo simulation were performed using a cost-minimization model. Results. 40 (17.1%) of hysterectomies for endometrial cancer were robotic, 91 (38.9%), were abdominal, and 103 (44.0%) were laparoscopic. 96.3% of the variation in operative cost between patients was predicted by operative time ( , ). Mean operative time for robotic hysterectomy was significantly longer than other methods ( ). Abdominal hysterectomy was consistently the most expensive while the traditional laparoscopic approach was consistently least expensive. The threshold in operative time that makes robotic hysterectomy cost equivalent to the abdominal approach is within the range of our experience. Conclusion. It is feasible for robotic hysterectomy to be less expensive than abdominal hysterectomy, but unlikely for robotic hysterectomy to be less expensive than traditional laparoscopy. 1. Introduction The burden of endometrial cancer worldwide is significant, particularly in developed nations battling concomitant epidemics of obesity [1]. In the USA and Europe, endometrial cancer has become the most common gynecologic malignancy and the fourth most common cancer site overall [2]. The primary treatment for endometrial cancer is total hysterectomy, bilateral salpingoopherectomy, and surgical staging [3, 4]. In the USA, the total annual cost of this surgery approximates 250 million [5]. Until the advent of operative laparoscopy, the traditional approach to the surgical management of endometrial cancer was total abdominal hysterectomy (TAH). With the diffusion of laparoscopic technology, there has been an increasing trend towards minimally invasive methods [6]. Several large randomized trials have demonstrated equivalent safety and short-term clinical outcomes between TAH and laparoscopic hysterectomy for endometrial cancer, including the Gynecologic Oncology Group¡¯s LAP-2 trial and the Australian LACE trial [7, 8]. Furthermore, these trials have demonstrated favorable quality of life outcomes for laparoscopic hysterectomy compared to TAH in terms of
%U http://www.hindawi.com/journals/ogi/2011/570464/