OBJECTIVES

: This study aimed to estimate the impact of surgical modality on economic burden to both patients and payer for treating endometrial cancer in Korea.

METHODS

: We identified patients aged ≥18 who underwent hysterectomy for endometrial cancer using data from the Korean National Health Insurance and Services (NHIS) claims database obtained from 2012 to 2016. Since robotic-assisted surgery (RAS) is not publicly reimbursed in Korea, the algorithm we employed to capture RAS cases identified patients hospitalized for endometrial cancer and including general anesthesia and biopsy codes, but not a hysterectomy code. Using inverse probability of treatment weighting (IPTW) matching, we controlled for baseline patient characteristics (age, income, hospital region, mCCI, comorbidity and chemoradiotherapy) to compare treatment costs of open (OPEN), laparoscopic (LAP) and RAS during inpatient and post-discharge period.

RESULTS

: The study included a total of 5,065 patients after IPTW matching (OPEN: 30%, LAP: 64% and RAS: 6%). Mean cost of initial hospitalization was USD 3,964 for OPEN, USD 3,814 for LAP and USD 2,081 for RAS. However, this estimate for RAS did not include a non-reimbursed operation charge (approximately ranging from USD 8,000 to 10,000). The mean cost of 30 day-readmission was the least for RAS group (USD 965), followed by LAP (USD 1,850) and OPEN (USD 1,933). RAS also showed significantly lower costs for emergency (USD 650) and outpatient visits (USD 306), compared to OPEN (USD 2,027, P<0.0001 and USD 547, P=0.0273).

CONCLUSIONS

: Despite the higher cost of hospitalization for robotic-assisted hysterectomy, total costs imposed on patients and the government during the 30-day postoperative period were lower, attributing to reduced readmission, emergency and outpatient visits. To demonstrate lifetime impact of cost-saving effect of RAS, a well-designed long-term cost-effectiveness study is necessary in Korea.