Open radical prostatectomy (ORP) and robotic-assisted radical prostatectomy (RARP) for prostate cancer are associated with similar cumulative healthcare costs and use at 1 year after hospital discharge, a new study suggests.

The finding suggests that lower post-discharge healthcare use after RARP may offset the higher costs during the initial hospitalization for prostate surgery, according to investigators.

The study, by Kennedy E. Okhawere, MD, MPH, of the Icahn School of Medicine at Mount Sinai in New York, New York, and colleagues, included 11,457 patients: 1604 (14%) who underwent ORP and 9853 (86%) who underwent RARP. Compared with the ORP group, those who underwent RARP had a mean $2367 higher cost at the index hospitalization, but similar total cumulative costs within 180 days (mean difference $397) and at 1 year after discharge (mean difference $383), Dr Okhawere and colleagues reported in JAMA Network Open.

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Healthcare use at 1 year after discharge was significantly lower in the RARP vs ORP group with respect to the proportion of patients who made emergency department visits (25.2% vs 28.0%) and hospital outpatient visits (76.4% vs 78.3%). Reduction in healthcare use in the RARP group translated into significant additional savings of $2929 ($20,276 for ORP vs $17,347 for RARP) and a significant 1.69 fewer days missed from work for healthcare visits (14.82 for ORP vs 13.12 days for RARP). Compared with ORP, RARP was associated with an approximately $2000 reduction in outpatient therapeutic radiologic expenditures during the postoperative period, the investigators reported.

Both treatment arms had similar hospital readmission rates (ORP 9.2% RARP 8.4%).

Dr Okhawere and colleagues posited “that, from a society perspective, there will be additional health care cost savings for patients who undergo RARP because they have fewer missed days from work and reduced health care use owing to the associated morbidity related to the procedure that is less than the morbidity of the ORP.”

In an accompanying commentary, Bogdana Schmidt, MD, MPH, and John T. Leppert, MD, MS, of Stanford University Medical School in Sanford, California, said Dr Okhawere and colleagues “present reassuring data that the adoption of robotic-assisted radical prostatectomy has not placed undue financial burden on the system.”

They added, “As urologists, we have the unique opportunity to innovate and improve care for our patients, and as clinicians, we have a responsibility to act as cost arbiters for the health care system. To serve our mission, we must acknowledge short-term costs but maintain a wide lens to improve value in surgical care.”


Okhawere KE, Shih IF, Lee SH, Li Y, Wong JA, Badani KK. Comparison of 1-year health care costs and use associated with open vs robotic-assisted radical prostatectomy. Published online March 1, 2021. JAMA Netw Open. doi:10.1001/jamanetworkopen.2021.2265

Schmidt B, Leppert JT. Costs of robotic-assisted radical prostatectomy 1 year after surgery: Pay now and save later? Published online March 1, 2021 JAMA Netw Open. doi:10.1001/jamanetworkopen.2021.2548