Cost-analysis of Implementing Robot-assisted Versus Open Pancreatoduodenectomy.

OBJECTIVE

To perform a cost analysis during the implementation of robot-assisted pancreatoduodenectomy (RPD) in a high-volume center.

BACKGROUND

Many high-volume centers are implementing RPD as an alternative to open pancreatoduodenectomy (OPD) but the persevering concerns about increased costs of RPD versus OPD have not been addressed by large studies.

METHODS

Post hoc cost analysis of consecutive RPD versus OPD in a singly high-volume center (January 2015-June 2024). The eligibility criteria for RPD (ie, no vascular contact, no chronic and necrotizing pancreatitis, and body mass index <35 kg/m 2 ) were used to select patients undergoing OPD to minimize selection bias. Primary outcomes were total hospital costs and total hospital stay. Sensitivity analyses excluded the first half of the RPD experience.

RESULTS

Overall, 588 patients undergoing pancreatoduodenectomy were included (214 RPDs, 374 OPDs). Total hospital stay was shorter after RPD [10 days (6 to 17) vs 12 (8 to 21), P = 0.001]. Mean total hospital costs were €4804 higher for RPD (€27,307 vs €22,503, P = 0.010). Outcomes improved in the second half of the RPD experience (n = 107): total hospital stay [12 days (7 to 23) to 9 (6 to 15), P < 0.001], pancreatic fistula (48.6% to 31.8%, P = 0.012), delayed gastric emptying (33.6% to 15.0%, P = 0.001), and operative time [373 minutes (341 to 411) to 310 (272 to 352), P <0.001]. Consequently, costs per RPD procedure decreased by €11,058 (€32,836 to €21,778, P = 0.001). Costs in the second half of the OPD experience remained stable (€24,025 to €21,013, P = 0.210). Hence, total hospital costs for RPD and OPD became comparable in the second half (€21,778 vs €21,013, P = 0.644).

CONCLUSIONS

Implementing RPD is associated with considerable additional costs compared with OPD. With growing experience, both the outcomes and cost-efficiency of RPD improve, with costs decreasing by approximately a third, leading to similar costs as OPD. Large-scale randomized trials will have to confirm these findings.