The Comparative Healthcare Cost between Robotic Esophagectomy and Video-Assisted Esophagectomy for Esophageal Cancer in Japan

OBJECTIVES: Esophagectomy is known to be invasive and challenging procedure. Since the introduction of minimally invasive esophagectomy, there have been improvements in post-operative morbidity, but its economic impact is still unknown. In this study, we explored the cost of minimally invasive surgery and the impact of surgical options on costs using Japanese population dataset.

METHODS: Adult patients who underwent elective Robot-Assisted Esophagectomy (RAE) or Video-Assisted Esophagectomy (VAE) with primary diagnosis of esophageal cancer from April 2018 to December 2022 were extracted from the Japan Medical Data Vision (MDV). We estimated the healthcare costs of esophagectomy during hospitalization up until 90 days after discharge. 1:1 propensity score matching (PSM) was used to compare the costs by surgical modalities.

RESULTS: We identified 4,407 patients (RAE:3,960 VAE :447). Before matching, RAE patients showed higher metastasis and wider spreads to nearby lymph nodes in baseline characteristics. After matching, 447 RAE and 447 VAE patients were included. RAE showed lower mean cost during hospitalization (RAE $30,573 (4576.35), VAE $31,723 (4742.89), p<0.001) and at 90 days after discharge (RAE $31,614 (5303.21), VAE $32,713 (5323.32), p=0.033). During hospitalization, RAE cost was lower in examination (RAE $1,777 (600.2), VAE $1,891 (632), p=0.009), hospitalization service (RAE $8,132 (2815.31), VAE $9,232 (2969.58), p<0.001), management (RAE $152 (96.45), VAE $176 (104.95), p<0.001), treatment (RAE $249 (190.04), VAE $314 (231.05), p<0.001), and injection ((RAE $681 (629.8), VAE $901 (719.69), p<0.001). VAE illustrated lower cost in anesthesia (RAE $3,750 (1660.13), VAE $3,493 (1403.10), p=0.009) and surgery (RAE $15,038 (2198.55), VAE $14,762 (1410.02), p=0.025). RAE showed higher ICU admission rate (83.4%) (VAE 73.6% (p<0.001)), while shorter post Length of Stay (LOS) 21.05(9.01) days (VAE 24.15(12.27)).

CONCLUSIONS: The study demonstrated improved cost outcomes of RAE over VAE among Japanese studied population. RAE saved $1,150 on average during hospitalization and reduced post-LOS by 3 days compared to VAE.