OBJECTIVES : Robotic-assisted surgery has been introduced into a range of hospitals in the UK. This study aims to assess the budget impact of increasing adoption of robotic-assisted radical prostatectomy (RARP) compared with open radical prostatectomy (ORP) and laparoscopic radical prostatectomy (LRP) from the perspective of the UK National Health Service (NHS).

METHODS : A Markov cohort model was developed to estimate budget impact over 10 years for the three surgical approaches from the NHS perspective, with the transitional states of surgery, surveillance, recurrence, and death. Costs for surgical treatment, hospitalization, monitoring, dysfunction treatment, adjuvant therapy, adverse events, recurrence and end-of-life were included. Model inputs were derived from the published literature and NHS 2017-2018 reference cost. Information on surgical equipment and instrument cost was based on UK public listing price. Deterministic and probabilistic sensitivity analyses were conducted to assess parameter uncertainty. Scenario analysis was conducted to include or exclude capital cost.

RESULTS : Although the cost of RARP was more than ORP and LRP during hospitalization when capital cost was included, the total cost per RARP after 10 years’ follow-up was €752 lower than ORP and € 1277 lower than LRP. Assuming that RARP will be increased from 75% to 84%, LRP decreased from 9% to 2 % and ORP decrease from 16% to 14%, NHS could have total budget savings of €129K over 10 years. If capital cost is removed from the calculation, further scenario analyses suggest NHS could achieve cost saving in the first year.

CONCLUSIONS : Our study suggests modest increases in the adoption of RARP would not increase total budget for NHS over 10 years. Initial capital investment for the da Vinci robotic-assisted surgical platform could be offset by cost savings from improved short-term and long-term clinical benefits. Further research is needed to demonstrate and validate long-term benefits of RARP and its financial impact.