Cost comparison of open approach, transoral laser microsurgery and transoral robotic surgery for partial and total laryngectomies

Activity-based costing is used to give a better insight into the actual cost structure of open, transoral laser microsurgery (TLM) and transoral robotic surgery (TORS) supraglottic and total laryngectomies. Cost data were obtained from hospital administration, personnel and vendor structured intervi...

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Bibliographic Details
Published in:European archives of oto-rhino-laryngology 2014-10, Vol.271 (10), p.2825-2834
Main Authors: Dombrée, Manon, Crott, Ralph, Lawson, Georges, Janne, Pascal, Castiaux, Annick, Krug, Bruno
Format: Article
Language:English
Subjects:
Costs and Cost Analysis
Head and Neck Surgery
Humans
Laryngectomy - economics
Laryngectomy - methods
Laser Therapy - methods
Medicine
Medicine & Public Health
Microsurgery - economics
Microsurgery - methods
Miscellaneous
Mouth
Natural Orifice Endoscopic Surgery - economics
Natural Orifice Endoscopic Surgery - methods
Neurosurgery
Operative Time
Otorhinolaryngology
Robotics - economics
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Summary:Activity-based costing is used to give a better insight into the actual cost structure of open, transoral laser microsurgery (TLM) and transoral robotic surgery (TORS) supraglottic and total laryngectomies. Cost data were obtained from hospital administration, personnel and vendor structured interviews. A process map identified 17 activities, to which the detailed cost data are related. One-way sensitivity analyses on the patient throughput, the cost of the equipment or operative times were performed. The total cost for supraglottic open (135–203 min), TLM (110–210 min) and TORS (35–130 min) approaches were 3,349 € (3,193–3,499 €), 3,461 € (3,207–3,664 €) and 5,650 € (4,297–5,974 €), respectively. For total laryngectomy, the overall cost were 3,581 € (3,215–3,846 €) for open and 6,767 € (6,418–7,389 €) for TORS. TORS cost is mostly influenced by equipment (54 %) where the other procedures are predominantly determined by personnel cost (about 45 %). Even when we doubled the yearly case-load, used the shortest operative times or a calculation without robot equipment costs we did not reach cost equivalence. TORS is more expensive than standard approaches and mainly influenced by purchase and maintenance costs and the use of proprietary instruments. Further trials on long-term outcomes and costs following TORS are needed to evaluate its cost-effectiveness.
ISSN:0937-4477
1434-4726
DOI:10.1007/s00405-014-3056-9