The benefits of robotically-assisted surgery for patients with kidney cancer outweigh the healthcare and surgical costs by a ratio of five to one. This is according to new research published in Health Affairs. The study, co-authored by Dana Goldman, set out to determine if the cost investment in a surgical robot could be linked to improvements in long-term patient outcomes.
Why Look at Kidney Cancer?
The prevalence of kidney cancer and the increasing use of robots for its surgical treatment, as well as the availability of long term costs and benefits data make kidney cancer a useful case study to analyze robotic surgery outcomes. Kidney cancer is generally treated through a partial or full nephrectomy. A complete nephrectomy involves removing all of the kidney whereas during a partial nephrectomy only part of the kidney is removed.
Using a data sample from the National Cancer Registry linked with Medicare Claims from 1996-2010, the researchers analyzed patient cost and outcomes data for Medicare beneficiaries ages 65 and older, who were diagnosed with kidney cancer between 1996 and 2010 and had a nephrectomy. Goldman and his colleagues analyzed the rates of partial and full nephrectomies for hospitals with and without robotic assistance technology and matched costs and benefits with health outcomes.
What are the Key Findings?
The findings suggest that for appropriate patients with kidney cancer, access to a partial nephrectomy option improved health outcomes and robot-assisted surgeries increased rates the procedure was done.
The researchers found that availability of robotic assistance technology was linked to an increase in partial nephrectomies by 52%. This is important because the researchers found that partial nephrectomies were associated with significantly lower rates of renal failure when compared with full or radical nephrectomies. They found no evidence that the availability of robot-assisted minimally invasive surgeries increased the likelihood that inappropriate patients received partial nephrectomy.
The long-term value of the procedure for patients surpassed the short-term costs of technology and surgical care. The five-year net benefit for full nephrectomy was $406,217 and $512,561 for partial nephrectomy patients; the positive difference ($106,344) indicates a net benefit to partial nephrectomy patients. The study also found that increased partial nephrectomy rates was associated with improvements in mortality rates and reduced rates of renal failure.
Can Policy Changes Improve the Situation?
The data suggests that robot-assisted surgeries are beneficial for a particular patient population; the issue is availability of these devices. Goldman and his co-authors estimated the extent to which partial nephrectomy rates would have increased had all hospital referral regions (HRRs) acquired robotically assisted technologies and found that if all HRRs had adopted the robot, an additional 23,166 partial nephrectomies would have been performed implying a total value of $2.5
The policy implications around measuring cost and access for treatments that come out of this study are important. “This study demonstrates the benefits – and pitfalls – of comparative research,” said Goldman. “While multiple surgical techniques may be equally beneficial, it turns out only robotic surgery can ensure that more patients get the best treatment.” Incorporating long term benefits into the cost equations for treatments and technologies as the researchers have done might shift investment strategies towards better treatment options.