OBJECTIVES: The robot-assisted surgery system, or da Vinci system (dV), got reimbursed for the surgery of the rectal cancer in Japan in Apr. 2018, without any premiums. Additional evidence of relative benefits for patient were needed for getting premiums. Our objective is to assess the healthcare resource use of the dV against open and laparoscopic surgery for rectal cancer patients in Japan.

METHODS: The claims data for hospitals with DPC (DRG-like flat payment system), obtained from Medical Data Vision Co., Ltd. were used for the analysis. Patient with the rectal cancer and received either open surgery, Laparoscopy surgery (LAP), or dV were included for the analysis. The following components of healthcare resource use were measured; the length of hospitalization (entire length and after surgery), medical costs (hospitalization and whole one). Data were compared using the propensity score matching (PSM), incorporating six factors (age, gender, BMI, smoking history, stage of disease and the Charlson Comorbidity Index (CCI)).

RESULTS: A total of 16,541 patients were incorporated to the analysis. Using the PSM, 607 and 655 pairs of patients were matched for comparison against open and laparoscopic surgery, respectively. The length of hospitalization in dV arm was shorter than open surgery (18.3 days vs 23.2 days, p<0.01), while similar to laparoscopic surgery (18.2 days vs 18.8 days, p=0.84). The da Vinci arm was less costly for overall costs (1year after surgery), for both against open surgery (JPY2.95Million vs JPY2.65Million) and laparoscopic surgery (JPY2.86Million vs JPY2.63Million).

CONCLUSIONS: Introduction of robotic surgery system may reduce overall healthcare costs in rectal cancer area.