THE ECONOMIC IMPACT OF ROBOTIC AND OPEN RADICAL PROSTATECTOMY ON PATIENTS AND THEIR FAMILIES

Purpose: Robotic-assisted laparoscopic prostatectomy (RALP) and open radical prostatectomy (ORP) have similar short-term clinical and functional outcomes.  RALP is more expensive than ORP, but it is not clear whether subsequent costs vary.  We assessed the economic impact of RALP and ORP on patients and their families.

Method: We recruited ORP and RALP patients planning surgery for stage T1-T2 prostate cancer at a large, urban academic cancer center.  Men who had prior chemotherapy, hormonal therapy or radiation for prostate cancer were excluded.  Economic impact questionnaires were completed at 3 and 6 months after surgery.  The self-administered survey included items regarding the use and cost of health services and supplies, health insurance coverage and employment, and changes in the patient’s and his family’s finances since cancer surgery. 

Result: Between June 2010 and April 2012, 309 of 536 eligible patients consented (58% response rate), and 163 completed a 6-month assessment, of whom 46% had ORP and 54% had RALP.  All patients had health insurance.  Of 125 men who reported any new prescription medications since surgery, 22% said insurance did not cover any of the cost of these medications.  Of 135 men who reported new use of incontinence pads, 73% had no insurance coverage for these costs and 36% were uncertain.  Of 124 men who were working full- or part-time before surgery, 41% missed more than 4 weeks of work and 19% had no paid sick days.  More than 20% of men said their monthly income was lower and 39% said their monthly expenses were greater than before surgery.  Almost 87% of men said that since surgery they spent money on hospital, physician or other provider bills, medications, supplies or alternative therapies.  About 36% said that since surgery they or their families had to downscale their lifestyle, not pay bills or pay them late, or use money from savings.  Men who had RALP (vs. ORP) were more likely to report use of incontinence pads (89% vs. 76%, p<0.01), but other differences between the two surgical approaches were not statistically significant.

Conclusion: Both RALP and ORP are associated with an economic burden on patients and their families, and many post-operative costs are not covered by health insurance.  Neither approach appears to have an economic advantage from the patient perspective.