Manraj N Kaur1, Feng Xie2, Andrea Shiwcharan3, Lisa Patterson4, Yaron Shargall5, Christian Finley5, Colin Schieman6, Terry Dalimonte7, Christine Fahim8, Waël C Hanna9. 1. School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada. 2. Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada. 3. Funding Reform and Case Costing, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada. 4. Boris Family Center for Robotic Surgery Research Program, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada. 5. Boris Family Center for Robotic Surgery Research Program, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada; Division of Thoracic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada. 6. Section of Thoracic Surgery, University of Calgary, Calgary, Alberta, Canada. 7. St. Joseph's Home Care, Hamilton, Ontario, Canada. 8. Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada; Boris Family Center for Robotic Surgery Research Program, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada. 9. Boris Family Center for Robotic Surgery Research Program, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada; Division of Thoracic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada. Electronic address: hannaw@mcmaster.ca.
Abstract
BACKGROUND: The objective of this study is to compare robotic portal (RP) to video-assisted thoracoscopic surgery (VATS) pulmonary resections for early stage non-small cell lung cancer with respect to health care resource utilization during the first year of a robotic surgery program in thoracic oncology. METHODS: Patients who underwent anatomic lung resections using RP (n = 42) or VATS (n = 96) for early stage non-small cell lung cancer between April 2014 and March 2015 at a single institution were identified. Patient-level case costing data for hospital and home care-associated resource variables were recorded. We adopted a health care payer perspective and 30-day posthospital discharge/death time horizon. Parametric or nonparametric tests were used as appropriate and incremental cost difference using 10,000 bootstrap samples using bias-corrected and accelerated method to generate 95% confidence intervals for total cost. RESULTS: Baseline demographic and clinical characteristics were comparable between the two groups. The median total hospital cost per patient was $15,247 (95% confidence interval: $15,643 to $18,945) in the RP cohort, compared with $12,131 (95% confidence interval: $13,218 to $15,879) in the VATS cohort (n = 96; p < 0.001). Longer operating times in the RP group were the main driver of higher hospital costs. Post-hoc analysis of mean operating room time for first 20 RP procedures versus remaining 22 RP procedures found a mean difference of 71 minutes (p = 0.004), resulting in an intraoperative cost difference of $883.38 (p = 0.036). CONCLUSIONS: A micro-costing analysis demonstrates that RP pulmonary resection for early stage non-small cell lung cancer utilizes more health care resource dollars when compared with VATS during early program development, but offers similar perioperative outcomes.
BACKGROUND: The objective of this study is to compare robotic portal (RP) to video-assisted thoracoscopic surgery (VATS) pulmonary resections for early stage non-small cell lung cancer with respect to health care resource utilization during the first year of a robotic surgery program in thoracic oncology. METHODS:Patients who underwent anatomic lung resections using RP (n = 42) or VATS (n = 96) for early stage non-small cell lung cancer between April 2014 and March 2015 at a single institution were identified. Patient-level case costing data for hospital and home care-associated resource variables were recorded. We adopted a health care payer perspective and 30-day posthospital discharge/death time horizon. Parametric or nonparametric tests were used as appropriate and incremental cost difference using 10,000 bootstrap samples using bias-corrected and accelerated method to generate 95% confidence intervals for total cost. RESULTS: Baseline demographic and clinical characteristics were comparable between the two groups. The median total hospital cost per patient was $15,247 (95% confidence interval: $15,643 to $18,945) in the RP cohort, compared with $12,131 (95% confidence interval: $13,218 to $15,879) in the VATS cohort (n = 96; p < 0.001). Longer operating times in the RP group were the main driver of higher hospital costs. Post-hoc analysis of mean operating room time for first 20 RP procedures versus remaining 22 RP procedures found a mean difference of 71 minutes (p = 0.004), resulting in an intraoperative cost difference of $883.38 (p = 0.036). CONCLUSIONS: A micro-costing analysis demonstrates that RP pulmonary resection for early stage non-small cell lung cancer utilizes more health care resource dollars when compared with VATS during early program development, but offers similar perioperative outcomes.
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