New Technology and Health Care Costs—The Case of Robot-Assisted Surgery, a Perspective article in the August 19, 2010, issue of the New England Journal of Medicine (NEJM), provides an excellent commentary about robotic technology and the concerns surrounding its rapid diffusion into the United States health care system. This article supports Hayes’ assessment that current evidence fails to demonstrate superior health outcomes for robotic procedures compared with other surgical techniques.

The authors, Dr. Gabriel Barbash and Dr. Sherry Glied, report that the number of robot-assisted procedures performed worldwide increased from 80,000 in 2007 to 205,000 in 2009. The number of da Vinci® systems installed in hospitals in the United States grew from nearly 800 to approximately 1400 during the same 2-year time period, even though large-scale randomized trials of the technology are lacking.

Robotic technology clearly drives up health care costs. Barbash and Glied analyzed data on the number of robotically assisted procedures and associated costs derived from the Healthcare Cost and Utilization Project (http://hcupnet.ahrq.gov). The results showed that, on average, robot-assisted surgery added an additional $1600, or 6% of the cost of the procedure, in 2007. As an example, the mean cost in 2007 of a laparoscopic cholecystectomy was $10,366; the use of a robot increased the cost by $1700.

Hayes, Inc. has evaluated a number of robot-assisted surgeries (see report list below) and concurs that additional research, including comparative-effectiveness studies, is needed to support the diffusion of this technology. It is unclear whether the advantages of using the robotic approach outweigh the disadvantages, which include the high cost of purchasing and maintaining the equipment. Although the advances of new technologies and the demand for less invasive techniques are hard to ignore, randomized comparative trials providing clinical quantifiable benefits of robotic surgery are lacking. This evidence gap illustrates a serious problem that occurs with premature diffusion of a technology.

Robotic surgical systems are associated with high fixed costs for each unit, substantial facility impact, and significant expense associated with maintenance and disposables. Until clinical outcomes for robotic-assisted procedures are proven to be better than those for conventional approaches, many payers have chosen to reimburse at the same rate for robotic and nonrobotic procedures, which leads to the question of how the cost of the robotic procedures will be covered.

Our evidence reviews can help payers to develop or revise coverage policies for robot-assisted surgery. Hayes also can help providers determine what impact the purchase of a robotic surgical system will have on hospital costs and to weigh the benefits and risks of acquiring this technology. Below is a select listing of reports within the Hayes Knowledge Center that address the da Vinci® technology, as well as other robotic technologies.

For assistance with your robotic technology decisions or to purchase one of the below reports, complete the inquiry form or call us at 215.855.0615.

Robotic Technology Reports
(* indicates reports addressing robotic technologies other than the da Vinci® system)

• CyberKnife® (Prognosis) April 29, 2010 *
• CyberKnife® Robotic Radiosurgery System (Accuray Inc.) for Lung Cancer and Other Non-Neurological Indications (HT Brief) Latest Update Search: February 9, 2010 *
• DigiMatch™ Robodoc® System (Prognosis) *
• Innovations in Cardiovascular Operating Room (Prognosis Trends Report) July 28, 2008 *
• MAKOplasty® (MAKO Surgical Corporation) (Search & Summary) May 20, 2010 *
• Pediatric Robotically Assisted Surgery (Directory) July 2, 2010
• Robotically Assisted Cardiac Valve Replacement Using the da Vinci Robotic System (Intuitive Surgical Inc.) (HT Brief) Latest Update Search: May 19, 2010
• Robotically Assisted Coronary Artery Bypass (Directory) Latest Update Search: November 3, 2009
• Robotically Assisted Hysterectomy (Directory) June 7, 2010
• Robotically Assisted Mitral Valve Repair Using the da Vinci® Surgical System (Intuitive Surgical Inc.) (HT Brief) Latest Update Search: December 18, 2009
• Robotically Assisted Nephrectomy for Renal Malignancy Using the da Vinci Surgical System (Intuitive Surgical Inc.) for Adult Patients (Search & Summary) March 16, 2010
• Robotically Assisted Nephrectomy for Renal Malignancy Using the da Vinci® Surgical System (Intuitive Surgical Inc.) for Adult Patients (HT Brief) Latest Update Search: May 14, 2010
• Robotically Assisted Nephrectomy for Renal Malignancy Using the da Vinci Surgical System (Intuitive Surgical Inc.) for Pediatric Patients (Search & Summary) March 16, 2009)
• Robotically Assisted Stereotactic Surgery (Directory) Latest Update Search: June 8, 2009 *
• Robotic-Assisted Prostatectomy (Directory) Latest Update Search: February 11, 2010
• Sensei® X Robotic Catheter System (Hansen Medical Inc.) (Search & Summary) October 6, 2010 *