Subscribe
Urology Practice Management - June 2015, Vol 4, No 3 - Prostate Cancer
Rosemary Frei, MSc

An analysis using the IMS LifeLink Health Plan Claims Database has shown that patients who undergo minimally invasive robotic-assisted radical prostatectomy experience a shorter hospital length of stay and somewhat better postoperative outcomes than patients who undergo open radical prostatectomy, albeit with a higher price tag, according to a study that was published recently in Prostate Cancer and Prostatic Disease.1

Senior author Nilay Shah, PhD, Consultant, Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN, and colleagues from across the United States used the LifeLink database to select privately insured patients with prostate cancer who underwent open radical prostatectomy or minimally invasive radical prostatectomy in the United States between 2003 and 2010.

“The primary outcomes of this study were LOS [length of stay], perioperative complications, 90-day readmission rates, and total hospital reimbursement,” Dr Shah and colleagues wrote. “We defined perioperative complications similar to previous studies examining the comparative effectiveness of MIRP [minimally invasive robotic-­assisted radical prostatectomy] versus ORP [open radical prostatectomy].”

The LifeLink database included 8629 patients who underwent open radical prostatectomy in 2003-2010, and 8981 who underwent the minimally invasive radical prostatectomy during the same time period; a total of 4092 surgeons performed these procedures. The rate of minimally invasive radical prostatectomy quickly eclipsed that of open radical prostatectomy, with 1.0% of patients receiving minimally invasive radical prostatectomy in 2003 and 74% in 2010. The members of the 2 groups had similar average ages—approximately 58 years—and number of comorbidities.

The median length of stay was 1 day for patients in the minimally invasive radical prostatectomy group and 3 days for those in the open radical prostatectomy group (P <.0001). The rates of wound, vascular, and medical perioperative complications were statistically similar for patients in the 2 groups. There was, however, a significantly lower rate of respiratory complications for patients who underwent minimally invasive radical prostatectomy compared with those undergoing open radical prostatectomy, at 0.7% versus 1.1%, respectively (P = .005). There was also a lower rate of genitourinary complications, at 1.2% versus 1.7% (P = .007), respectively. As a result, the rate of overall complications was lower for patients who underwent minimally invasive radical prostatectomy: 2.1% versus 3.0% (P <.001), respectively.

The researchers’ analysis revealed a 24% lower adjusted risk of genitourinary complications (adjusted odds ratio [OR], 0.76; P <.001) for patients undergoing minimally invasive radical prostatectomy and an 18% lower adjusted risk of overall complications (adjusted OR, 0.82; P <.001). The 90-day readmission rates were similar for patients in both groups: 5.2% for patients in the minimally invasive radical prostatectomy group and 5.3% for those in the open radical prostatectomy group (P = .85).

Mean hospital reimbursement was significantly higher for the minimally invasive radical prostatectomy procedure, at $19,292 per procedure compared with $17,347 for the open radical prostatectomy procedure (P <.001). This translates into approximately $126.4 million in additional reimbursement provided to hospitals for performing robotic surgery from 2003 to 2010, the authors calculated.

Dr Shah said that more information is required for a formal cost-­effectiveness analysis.

“Specifically, we would have to survey patients at different time points after surgeries to be able to calculate QALYs [quality-adjusted life-years]. This data is not yet available, but would be an additional piece of information to further understand the impact of different types of surgeries,” he observed.

Reference

  1. Kim SP, Gross CP, Smaldone MC, et al. Perioperative outcomes and hospital reimbursement by type of radical prostatectomy: results from a privately insured patient population. Prost Cancer Prost Dis. 2015;18:13-17.
Related Items
Adding Abiraterone to ADT May Decrease Resource Utilization in Castration-Naïve Prostate Cancer
Wayne Kuznar
Urology Practice Management - Web Exclusives published on July 24, 2018 in Prostate Cancer
Apalutamide and Enzalutamide Each Delays Prostate Cancer Metastasis by Approximately 2 Years
Urology Practice Management - Web Exclusives published on May 31, 2018 in Prostate Cancer
Abiraterone Is Game-Changer in the Frontline Treatment of Advanced Prostate Cancer
Wayne Kuznar
Urology Practice Management - Web Exclusives published on July 21, 2017 in Prostate Cancer
Adding Antiandrogen Therapy to Radiation Improves Survival in Recurrent Prostate Cancer—A New Standard of Care?
Jessica Miller
Urology Practice Management - Web Exclusives published on May 15, 2017 in Prostate Cancer
Rise in Metastatic Prostate Cancer Has Screening, Treatment Implications
Charles Bankhead
Urology Practice Management - December 2016, Vol 5, No 6 published on December 7, 2016 in Prostate Cancer
Promising Antitumor Activity of ODM-201 in Metastatic Prostate Cancer
Wayne Kuznar
Urology Practice Management - December 2016, Vol 5, No 6 published on December 7, 2016 in Prostate Cancer
Is the Glass Half Empty or Half Full? First Study Compares Robotic-Assisted Surgery and Open Radical Prostatectomy
Alice Goodman
Urology Practice Management - December 2016, Vol 5, No 6 published on December 7, 2016 in Prostate Cancer
IsoPSA, a New Biomarker Test, Differentiates High- and Low-Grade Prostate Cancer, Improves Diagnostic Accuracy
Wayne Kuznar
Urology Practice Management - October 2016, Vol 5, No 5 published on October 10, 2016 in Prostate Cancer
Shorter Hypofractionated Therapy New Standard for Prostate Cancer
Phoebe Starr
Urology Practice Management - October 2016, Vol 5, No 5 published on October 10, 2016 in Prostate Cancer
Referring Radical Prostatectomies to High-Volume Providers Could Save Millions
Chase Doyle
Urology Practice Management - August 2016, Vol 5, No 4 published on August 15, 2016 in Prostate Cancer
Last modified: June 15, 2015
  • American Health and Drug Benefits
  • Lynx CME
  • Value Based Care in Rheumatology
  • Oncology Practice Management
  • Urology Practice Management

Search