THE FINANCIAL IMPACT OF SYSTEM DOWN-TIME DURING ROBOT-ASSISTED GENERAL SURGERIES IN THE UNITED KINGDOM
Author(s)
Madison Montgomery, MScRes Health Economics, Anna Bowes, MSc Bioinformatics, Hayden Holmes, Post Graduate Diploma in Public Health.
York Health Economics Consortium, York, United Kingdom.
York Health Economics Consortium, York, United Kingdom.
OBJECTIVES: To evaluate the financial impact of system down-time for robot-assisted surgery (RAS) in the United Kingdom (UK) for general surgery
METHODS: A cost calculator was developed to estimate the annual impact of RAS system down-time within 10,500 estimated general surgery procedures in the UK. As our base-case we used an up-time of 99.89%, the reported up-time for the da Vinci RAS system. We used published sources to inform inputs and estimates. Intraoperative down-time was 81.7%, and 18.3% was applied to preoperative down-time, based on a previous retrospective review in gynaecology. Of those intraoperative cases, 3.2% were converted to open surgery, 28% were delayed, and 68.8% were completed without conversion or delay. For the preoperative procedures, we assumed 5% were converted and 95% were rescheduled. Intraoperative delay costs were calculated by multiplying an average 17.9-minute additional procedural delay by the per-minute operating room and staff rates. Intraoperative conversions were assumed to occur mid-procedure, incurring additional equipment costs alongside the four-day hospital length of stay (LoS) associated with open surgery. All costs were taken from existing literature and public cost data and inflated to the 2024-25 cost year. Only direct costs were included, and surgical site infection costs were excluded. To assess the difference in impact, system up-time was varied to 98%. This value was discussed with experts and considered conservative
RESULTS: We estimated that a reduction in RAS system up-time from 99.89% to 98% would result in 203 additional procedures experiencing down-time, incurring an additional annual down-time cost of £1 million (excluding non-delayed procedures) capturing rescheduling, operative, and LoS costs
CONCLUSIONS: Failing to account for RAS system down-time may result in uncaptured hospital expenditure. Despite addressing these costs, this study was limited by a paucity of data specific to general surgery indications. This demonstrates the need for consistent operational reporting for robust analytical methodologies
METHODS: A cost calculator was developed to estimate the annual impact of RAS system down-time within 10,500 estimated general surgery procedures in the UK. As our base-case we used an up-time of 99.89%, the reported up-time for the da Vinci RAS system. We used published sources to inform inputs and estimates. Intraoperative down-time was 81.7%, and 18.3% was applied to preoperative down-time, based on a previous retrospective review in gynaecology. Of those intraoperative cases, 3.2% were converted to open surgery, 28% were delayed, and 68.8% were completed without conversion or delay. For the preoperative procedures, we assumed 5% were converted and 95% were rescheduled. Intraoperative delay costs were calculated by multiplying an average 17.9-minute additional procedural delay by the per-minute operating room and staff rates. Intraoperative conversions were assumed to occur mid-procedure, incurring additional equipment costs alongside the four-day hospital length of stay (LoS) associated with open surgery. All costs were taken from existing literature and public cost data and inflated to the 2024-25 cost year. Only direct costs were included, and surgical site infection costs were excluded. To assess the difference in impact, system up-time was varied to 98%. This value was discussed with experts and considered conservative
RESULTS: We estimated that a reduction in RAS system up-time from 99.89% to 98% would result in 203 additional procedures experiencing down-time, incurring an additional annual down-time cost of £1 million (excluding non-delayed procedures) capturing rescheduling, operative, and LoS costs
CONCLUSIONS: Failing to account for RAS system down-time may result in uncaptured hospital expenditure. Despite addressing these costs, this study was limited by a paucity of data specific to general surgery indications. This demonstrates the need for consistent operational reporting for robust analytical methodologies
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE266
Topic
Economic Evaluation, Medical Technologies
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, Surgery