Introduction:

While health care costs attributable to robotic surgery for radical prostatectomy (RP) have been well described, actual reimbursements to hospitals and surgeons as well as the out-of-pocket costs for patients remain largely unknown.  Thus, we sought to describe reimbursements to the health care system and costs to prostate cancer (PCa) patients among a privately-insured, population-based cohort.

Methods:

Using MarketScan, a national private health insurance database, we identified all PCa patients who underwent open radical prostatectomy (ORP) or robotic-assisted laparoscopic prostatectomy (RALP) from 2010 to 2015.  Patient-level reimbursements to hospitals and surgeons (technical fees) and out-of-pocket from patients (co-pay) represented the primary outcomes.  Generalized estimating equations were used to provide estimates of each outcome adjusting for age, Elixhauser comorbidity index, postoperative complications, length of stay (LOS) and year of surgery. 

Results:

Among the 46,884 patients surgically treated for PCa, use of RALP increased from 40.6% in 2010 to 62.5% in 2015 (p < 0.001 for trend).  The mean age was 58 years old (SD: 5.0).  Compared to ORP, patients undergoing RALP had lower mean LOS (1.5 vs. 1.9 days; p < 0.001) and rates of postoperative complications (1.7% vs. 2.3%; p < 0.001).  On multivariable analysis, RALP was responsible for higher adjusted hospital reimbursement compared to ORP and rose from 2010 ($16,919 vs. 15,701, p < 0.001) to 2015 ($20,197 vs. $18,979; p < 0.001).  Conversely, physician reimbursement was higher each year for ORP relative to RALP ($3,272 vs. $2,931; p < 0.001 in 2010 to $3,914 vs. $3,572; p < 0.001 in 2015).  Patient out-of-pocket costs were slightly higher for RALP ($188 vs. $164; p < 0.001) with no statistically significant change over time.  

Conclusion:

While higher hospital reimbursements were observed for RALP and accounted for a majority of the healthcare dollars spent overall, physician reimbursement was higher for ORP.  Patient out-of-pocket costs were low for both surgical approaches.   Further research is needed to better define the costs and reimbursement of RALP to identify opportunities to provide more cost-effective health care.  

Funding: N/A