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Thomas Flaig, MD


Comparing the Cost of Robot-Assisted Versus Open Radical Cystectomy for Bladder Cancer

By: Sarah Lynch
Posted: Thursday, July 27, 2023

A group of researchers evaluated the cost-effectiveness of using robot-assisted radical cystectomy with intracorporeal urinary diversion compared with open radical cystectomy for patients in the treatment of bladder cancer. Based on their economic evaluation, which was published in JAMA Network Open, the intracorporeal urinary diversion technique reduced short-term morbidity and some associated costs.

“While reductions in morbidity from radical cystectomy have been achieved through robot-assisted radical cystectomy, the cost-effectiveness of these approaches is unclear,” stated Simon Dixon, PhD, of the University of Sheffield, United Kingdom, and colleagues. “A systematic review of economic studies of [robot-assisted radical cystectomy] and open radical cystectomy highlighted that the costs of the robot-assisted procedure are likely to be higher than open comparators, despite savings from reductions in complications.”

The researchers focused on data from 305 patients with nonmetastatic bladder cancer. They evaluated the costs of surgery using data from surgery timings and equipment costs, and they calculated quality-adjusted life-years according to the European Quality of Life 5-Dimension 5-Level instrument responses. The study focused on a 90-day window but continued to follow patient benefits for up to 1 year.

The researchers found that robot-assisted surgery was associated with reductions in admissions to intensive care and readmissions to hospital but longer periods in the operating room. Robot-assisted radical cystectomy was associated with fewer admissions to intensive therapy and fewer readmissions to the hospital. However, it was also associated with increases in operating theater time, as well as an additional cost of £1,124 ($1,452) per patient.

Overall, intracorporeal urinary diversion reduced short-term morbidity and certain treatment costs. Specific patient subgroups based on age, tumor stage, and performance status were determined for which the procedure had a higher probability of being cost-effective.

“Future research should examine patient subgroups and service settings where intracorporeal urinary diversion is most cost-effective, including an assessment of recovery using patient-reported outcome measures,” the investigators proposed.

Disclosure: For full disclosures of the study authors, visit

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