A new study, published in the February issue of Health Affairs, found that in terms of quality-adjusted life-years gained, the benefits of robotic-assisted partial nephrectomy surgery for kidney cancer patients outweighed the health care and surgical costs to patients and payers by a ratio of five to one.
The Precision Health Economics (PHE) study set out to determine if the investment in a surgical robot could be linked to improvements in long-term patient outcomes. The study found that partial nephrectomies had significantly lower rates of renal failure when compared with radical nephrectomies. The study also concluded that the costs incurred in adopting robotic-assisted surgery were offset by higher survival and lower renal impairment rates.
"Partial nephrectomy, or kidney-sparing surgery, is considered the standard of care for clinically appropriate patients as a means to slow the progression of renal failure and reduce the risk of dialysis," said Dr. Myriam Curet, Chief Medical Officer, Intuitive Surgical. "The PHE study demonstrates that those hospitals offering minimally invasive partial nephrectomies utilizing a da Vinci® Surgical System delivered both improved patient outcomes and considerable long-term economic benefits."
"The preferred and healthiest option to cure a small renal cancer is to perform a partial nephrectomy," said Sam B. Bhayani, M.D., M.S., Professor of Urology, Surgery Washington University School of Medicine and Chief Medical Officer, Vice President of Medical Affairs at Barnes-Jewish West County Hospital, Saint Louis, Missouri. "The most effective way for a hospital and surgeon to perform partial nephrectomy is to have access to robotic surgery."
Approximately 297,000 nephrectomies were performed in the United States from 2001 to 2010. The study found that adoption of robotic-assisted minimally invasive surgery (MIS) led to a 52 percent increase in the rate of kidney sparing partial nephrectomy versus full radical nephrectomy. The five-year net benefit per procedure (in terms of the difference between quality-adjusted survival gains and health care costs incurred) was $406,217 for radical and $512,561 for partial nephrectomy patients, for an incremental value of $106,344 for each patient who received partial rather than radical nephrectomy. The study found that if all hospital referral regions (HRRs) had adopted the da Vinci® Surgical System, there would have been an additional 23,166 partial nephrectomies performed over the study period. Valuing each partial nephrectomy procedure at $106,344, would have generated an additional $2.5 billion in value had the da Vinci® Surgical System been adopted across all HRRs.
"This study demonstrates the benefits – and pitfalls – of comparative research," said Dana P. Goldman, Director of the Leonard D. Schaeffer Center for Health Policy and Economics at the University of Southern California. "While multiple surgical techniques may be equally beneficial, it turns out only robotic surgery can ensure that more patients get the best treatment."
Of note, the study found no evidence that the availability of robot-assisted MIS increased the likelihood that inappropriate patients received partial nephrectomy. The study did find that use of robotically assisted surgery might increase access to partial nephrectomy, which is associated with improvements in one-year survival rates after surgery and large reductions in renal failure rates. HRRs most likely to offer partial nephrectomy attained significantly lower rates of renal failure in all three time periods studied.
The PHE study found that partial nephrectomy improved one-year mortality by 5.7 percentage points. In comparison, Hung-Jui Tan, et al found a 5.6 percentage-point improvement in two year mortality.