OBJECTIVES

The Robotic assisted surgical procedure had only been reimbursed for prostate / renal cancer patients under Japanese health insurance system. In 2018 it was expanded to twelve other disease areas, while no premium is given for extended area. Gastrectomy is thought to be important procedure among 12 ones in East Asia, as gastric cancer is more prevalent than that in Europe / the US. Our objective is to compare average length of stay (ALOS) and medical expenses among different surgery methods, or robotic-assisted, conventional, and open gastrectomy.

METHODS

Patients who underwent gastrectomies performed from 2012 to 2019 were identified using receipt codes in the Medical Data Vision (MDV), a hospital-based claims database. Receipt codes were further used to identify ALOS and medical expenses summarized for all health claim charges during the patient’s hospital visit for a gastrectomy procedure. Propensity score matching (PSM) was used to adjust confounding factors between RAS and laparoscopic (LP). PSM was performed only for patients undergoing surgery after 2018. Stratified analyses were conducted for treatment subgroup; distal, total, and proximal gastrectomies.

RESULTS

173 robotic-assisted gastrectomies compared to 24,900 laparoscopic and 37,718 open were identified. Crude results Mean ALOS (SD) were 15.25 (8.09) for RAS, 19.66 (15.95) for LP and 27.33 (22.16) for open, respectively. After PSM, 132 robotic-assisted gastrectomies and laparoscopic were identified. ALOS (SD) for RAS was significantly (p<0.01) shorter than laparoscopic, 14.55 (6.63) vs. 18.39 (11.14), and medical costs (SD) were significantly (p=0.020) lower for RAS than laparoscopic, JPY2,229,415 (JPY320,650) vs JPY2,336,989 (¥418,556).

CONCLUSIONS

From a public healthcare payer’s perspective, robotic-assisted gastrectomy may reduce medical expenses even if the clinical outcomes of RAS is equivalent to that of conventional laparoscopy. Further research is needed to evaluate additional benefit of robotic-assisted compared to other techniques.