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Effects of Robotic-Assisted Surgery for Prostatectomy on Treatment Centralization and Patient Hospital Choice

By: Chris Schimpf, BS
Posted: Wednesday, July 26, 2023

A study published in Health Economics Review investigated the impacts of the rise of robotic-assisted surgeries for radical prostatectomies on both treatment centralization and patients’ hospital choices. Examining data from hospitals in Germany, Professor of the School of Medicine at University of St. Gallen, Switzerland, Dr. Alexander Geissler, and colleagues, observed that the availability of robotic-assisted surgery appears to positively impact patients’ choice of hospital for radical prostatectomy, as well as procedure volumes at those hospitals. The investigators concluded that these factors contribute to increased centralization within the hospital landscape.

To assess procedure volume and centralization, the researchers employed a panel-data fixed effect model analyzing data from all German hospitals that performed at least one radical prostatectomy from 2006 to 2018. During that time, robotic-assisted surgeries for the procedure increased from 3% to 46%. And despite a slight decrease in the overall number of radical prostatectomies performed, hospitals that invested in robotic-assisted systems increased their case volumes by 82% compared with those that did not.

Regarding patients’ choice of hospital, the team used a random utility choice model to analyze patient-level data of 4,614 patients who underwent radical prostatectomies in 2015. Within that group, the researchers observed that patients were willing to travel 22% longer than average for hospitals offering robotic-assisted surgeries. In addition, they were willing to travel 13% longer for hospitals that were certified prostate cancer treatment centers and approximately 8% longer for specialization in the form of higher procedure volumes.

Of note, the investigators observed that both outcomes and service quality appeared to be of insignificant or negligible influence on patients’ hospital choice. In fact, they asserted that although “patients have been voting with their feet,” evidence of a direct, positive influence of robotic-assisted surgeries on outcomes of radical prostatectomies is currently ambiguous.

Disclosure: For full disclosures of the study authors, visit

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