Robot-assisted radical cystectomy is becoming a common treatment for bladder carcinoma. However, in comparison with open radical cystectomy, its cost-effectiveness has not been confirmed. Although few published reviews have compared total costs between the two surgical procedures, no study has compared segmental costs and explained their impact on total costs. A systematic review was conducted based on studies on the segmental costs of open, laparoscopic, and robot-assisted radical cystectomy using PubMed, Web of Science, and Cochrane Library databases to provide insight into cost-effective management methods for radical cystectomy. The segmental costs included operating, robot-related, complication, and length of stay costs. A sensitivity analysis was conducted to determine the impact of the annual number of cases on the per-case robot-related costs. We identified two studies that compared open and laparoscopic surgeries and nine that compared open and robotic surgeries. Open radical cystectomy costs were higher than those of robotic surgeries in two retrospective single-institution studies, while robot-assisted radical cystectomy costs were higher in 1 retrospective single-institution study, 1 randomized controlled trial, and 4 large database studies. Operating costs were higher for robotic surgery, and accounted for 63.1–70.5% of the total robotic surgery cost. Sensitivity analysis revealed that robot-related costs were not a large proportion of total surgery costs in institutions with a large number of cases but accounted for a large proportion of total costs in centers with a small number of cases. The results show that robot-assisted radical cystectomy is more expensive than open radical cystectomy. The most effective methods to decrease costs associated with robotic surgery include a decrease in operating time and an increase in the number of cases. Further research is required on the cost-effectiveness of surgeries, including quality measures such as quality of life and quality-adjusted life years.

中文翻译：

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膀胱癌患者行开放性根治性膀胱切除术，腹腔镜根治性膀胱切除术和机器人辅助性根治性膀胱切除术之间的费用比较：系统的分段费用回顾

机器人辅助根治性膀胱切除术正成为膀胱癌的常见治疗方法。但是，与开放性根治性膀胱切除术相比，其成本效益尚未得到证实。尽管很少有已发表的综述比较两种手术方法的总费用，但尚无研究比较分段费用并解释其对总费用的影响。基于对使用PubMed，Web of Science和Cochrane Library数据库进行的开放式，腹腔镜式和机器人辅助的根治性膀胱切除术的分段成本的研究，进行了系统的审查，以提供对成本有效的根治性膀胱切除术管理方法的见识。部门成本包括操作成本，与机器人相关的成本，复杂性和停留时间成本。进行了敏感性分析，以确定每年案例数对每例机器人相关成本的影响。我们确定了两项比较开放式和腹腔镜手术的研究，九项比较了开放式和机器人手术的研究。在两项回顾性单机构研究中，开放性根治性膀胱切除术的费用高于机器人手术的费用，而在一项回顾性单机构研究，一项随机对照试验和四项大型数据库研究中，机器人辅助性根治性膀胱切除术的费用则更高。机器人手术的运营成本较高，占机器人手术总成本的63.1–70.5％。敏感性分析表明，与机器人相关的费用在拥有大量病例的机构中并不是手术总费用的很大比例，但在病例较少的中心中占机器人总费用的很大比例。结果表明，机器人辅助根治性膀胱切除术比开放性根治性膀胱切除术更昂贵。减少与机器人手术相关的费用的最有效方法包括减少手术时间和增加病例数。需要对手术的成本效益进行进一步研究，包括质量指标，例如生活质量和质量调整寿命。减少与机器人手术相关的费用的最有效方法包括减少手术时间和增加病例数。需要对手术的成本效益进行进一步研究，包括质量指标，例如生活质量和质量调整寿命。减少与机器人手术相关的费用的最有效方法包括减少手术时间和增加病例数。需要对手术的成本效益进行进一步研究，包括质量指标，例如生活质量和质量调整寿命。