Dados do Trabalho

Título

Robotic-assisted versus laparoscopic incisional hernia repair: differences in direct costs from a Brazilian public institute perspective

Resumo

Background: This study aimed to compare the direct cost differences between robotic and laparoscopic hernia repair surgery and determine each source of expenditure that may be related to the increased costs in a robotic program from the perspective of a Brazilian public institution. Methods: The present study investigated the differences in direct costs from the data generated from a randomized trial protocol. Patients with incisional hernia were randomly assigned to receive any interventions: laparoscopic (LVIHR) or robotic-assisted surgery (RVIHR), with either an IPOM or a Rives-Stopa procedure. The direct medical costs of hernia treatment were described from the Institute’s perspective. Costs were expressed in the Brazilian currency (R$). Results: Nineteen patients submitted to LVIHR were compared with eighteen patients submitted to RVIHR. The amount spent on operation room time (RVIHR: 2447,91 ± 644,79; LVIHR: 1989,67 ± 763,00; p=0,030), inhaled medical gases in operating room (RVIHR: 270,57 ± 211,51; LVIHR: 84,55 ± 252,34; p=0,023), human resources in operating room (RVIHR: 3164,43 ± 894,97; LVIHR: 2120,16 ± 663,78; p<0,001), material resources (RVIHR: 3204,32 ± 351,55; LVIHR: 736,51 ± 972,32; p<0,001), and medications (RVIHR: 823,40 ± 175,47; LVIHR: 288,50 ± 352,55; p<0,001) for RVIHR was significantly higher than LVIHR, implying a higher total cost to the patient in RVIHR than in LVIHR (RVIHR: 14712,24 ± 3520,82; LVIHR: 10295,95 ± 3453,59; p<0,001). No significant difference was noted in costs related to the hospital stay, human resources in ICU and ward, diagnostic tests, prothesis, meshes, and special devices. Conclusion: Robotic system adds a significant overall cost to traditional laparoscopic hernia repair. The cost of the medical and robotic devices plus longer operative times are the main factors driving the difference in costs.