Introduction

_x000D_ Gold standard therapy for muscle invasive bladder cancer (BC) and high risk recurrent non-muscle invasive BC is radical cystectomy (RC) with pelvic node dissection. Traditionally this has been an open approach, however recent data demonstrates that robotic RC is a safe and viable option with good oncologic outcomes. A concern is the cost differential between open RC (ORC) and robotic RC (RRC). We perform a single center matched study comparing the total 90 day cost between open and radical cystectomy.

Methods

_x000D_ With IRB approval, we assessed a single center prospectively collected RRC database for patients between 2007 and 2015. We matched RRC cases 1:1 by age and year of surgery with a retrospective ORC database. All patients who underwent adjunct procedures and procedures with two or more surgeons were excluded from the study. We then performed a comparison of clinical and pathological variables as well as 90 day technical, professional and total costs, including hospital readmissions and complication related costs. Costs are represented as a fraction of RRC over the ORC. Student&[prime]s unpaired t-test and Fisher&[prime]s exact tests were used to analyze data between the two cohorts.

Results

_x000D_ We identified 126 RRC patients and matched the with 106 ORC patients. 83% of the RRC was male (104/126) vs. 78% (83/126) of the ORC group (P=0.501). Median age of RRC was 66.50 (61-73 IQR), and for ORC was 67 (61-74 IQR) (p=0.501). 33% of RRC vs. 37% of ORC were clinical stage < T2, 49% of RRC vs. 45% of ORC were cT2, and 18% RRC vs. 18% of ORC were > cT2 (p=0.491). Mean Charleston Comorbidity score was 1.3 (1.05 std. dev.) for RRC and 1.99 (1.89 std. dev) for ORC (p=0.006). 21% (26/126) of RRC and 13% (14/104) of ORC had a continent diversion. Of the RRC cases, 52% (65/126) of the diversions were done robotically. Median length of hospital stay was 6.5 days (5-9 IQR) for RRC and 7 days (5-9 IQR) for ORC (p=0.385)._x000D_ _x000D_ The 90 day total cost for RRC was 1.15 times greater than for the ORC cohort (p=0.084). Professional Fees for the RRC were 1.05 times greater than the ORC (p=0.3454) and the technical fees of RRC were 1.18 times that of the ORC (p=0.074). 82% of the cost for the RRC, and 81% of the ORC costs were technical. _x000D_

Conclusions

_x000D_ In a matched cohort, the total 90 day post-operative costs for robotic approach was not statistically significantly more than the open. This was primarily related to technical costs, and the initial capital required for either approach was not included.

Funding

None