Table 9.

Cost outcomes

Reference	Source of cost data	Cost outcomes (€)*
		Type of cost data	Robotic	Laparoscopic	Open	P
RCTs
Olavarria et al.20	Costs including all patient visits, admissions, and procedural costs from operation through first 90 postoperative days came from hospital administration accounting system. Cost did not include surgeons’ fees or initial acquisition cost of robotic or laparoscopic platforms	Mean costs	19 038 (5854)	15 546 (6763)	–	0.004
Petro et al.21	Values for cost reported as ratios. Total cost includes OR cost (as calculated by cost per minute of OR time required for the procedure) and disposable/reusable cost, which was calculated to include disposable materials as well as reusable materials including robotic instruments	Disposable/reusable median cost ratio	0.97 (0.85–1.51)†	1.00 (0.87–1.19)†	–	0.60
		OR time cost ratio	1.25 (0.98–1.49)†	0.85 (0.67–1.00)†	–	< 0.001
		Total cost ratio	1.13 (0.90–1.52)†	0.97 (0.85–1.16)†	–	0.03
Studies with propensity matching
Song et al.36¶	Total cost included direct cost and overhead cost, adjusted for inflation to 2015 US dollars	Total cost	12 422	–	12 989	n.s.
			12 562	12 908	–	n.s.
Studies without propensity matching
Armijo et al.13	Ratio of cost-to-charge method applied for estimating cost of patient care	Total direct cost	12 000 (8400, 16 800)‡	8400 (6000, 10 800)‡	10 800 (7200, 19 200)‡	< 0.050#
Coakley et al.14	Total hospital charges	Adjusted mean charges (controlling for CCI, geography, public versus private, etc.)	73 446(1717)	50 293(310)	–	< 0.001
Dauser et al.27	Procedure-related costs calculated exact to the minute Cost unit accounting for the postoperative inpatient stay done using data provided by controlling department. Earnings including subsidies, non-medical material costs, expenditures for physicians, nursing, medical technical assistance, pharmaceuticals, third-party suppliers, and maintenance were added. In addition, apportionment of indirect costs for ICU, operating theatre, radiology, outpatient clinic, management and administration were priced in for full cost accounting for inpatient stay in surgical ward. Costs per day in this setting amount to €493.63	Total procedure-related costs	5394.41	–	1987.19	–
		Cost of inpatient stay	2714.53	–	6662.93	–
		Total cost	8108.93	–	8650.12	–
Khorgami et al.29	Hospital total charges converted to cost estimates using hospital specific cost-to-charge ratios provided by HCUP. Admissions with total charges below 0.1th percentile or above 99.9th percentile were considered outliers and excluded from analysis	Average cost estimate	16 093(6648)	12 887(5774)	–	< 0.050
Tan et al.37¶	Primary outcome: disposable operating room costs Secondary outcomes: technical direct costs such as costs from laboratory or pharmacy	Median OR costs	3714 (3 532–3988)†	4069 (3204–5074)†	–	0.056
		Median total variable costs	5234 (4571–6433)†	5461 (4234–7399)†	–	0.609
Warren et al.39	No details provided	Mean direct hospital cost	23 438	16 732	–	0.07

^*Values are mean(s.d.) unless indicated otherwise;

^† values are median (i.q.r.);

^‡ values in parentheses are 95 per cent confidence intervals. Original charges in US dollars were converted to euros at an exchange rate of US $1.2 to €1.

^¶Conference abstract. OR, operating room; n.s., not significant; CCI, Charlson Co-morbidity Index; HCUP, Healthcare Cost and Utilization Project; #Two-way comparisons of robotic versus open and robot versus laparoscopic.