Presentation (CTI)

OBJECTIVES: To estimate the direct and indirect costs associated with da Vinci robotic-assisted surgery (dV-RAS) for prostatectomy in Spain versus open and laparoscopic approaches, from the Spanish National Health System (NHS) perspective.
METHODS: A cost analysis model was developed following Spanish methodological recommendations for economic evaluations by the Advisory Committee for the Financing of the Pharmaceutical Provision. A 1‑year time horizon without discounting was applied. Clinical inputs were derived from Spanish real‑world evidence, validated by a national clinical expert panel, and supplemented with the published COMPARE meta-analysis. Direct costs included operating room time, personnel, equipment, blood transfusions, hospital stay, and complications. Indirect costs captured productivity loss. Costs were updated to 2026 using the consumer price index.
RESULTS: Estimated intraoperative costs per patient were €5,535 for robotic, €5,385 for laparoscopic and €5,098 for open surgery. Robotic surgery was associated with shorter hospital stay and fewer complications resulting in lower postoperative cost (€3,914 dV-RAS, €4,875 laparoscopic, and €4,436 open). When including productivity losses, total societal costs were €10,697 for dV-RAS, €11,932 for laparoscopic, and €12,242 for open surgery.
CONCLUSIONS: Robotic-assisted radical prostatectomy is cost-saving compared with both open (-€1,545) and laparoscopic (-€1,236) surgery when considering total direct and indirect costs. Improved outcomes including reduced complications, shorter hospital stay, and early return to function, support the value and increasing adoption of robotic surgery within the Spanish NHS.