OBJECTIVES: Robotic surgery provides several advantages, such as enhanced reproducibility and predictability through accurate execution of the preoperative plan but it is also associated with a higher capital investment which limits its widespread use. The aim of this analysis is to estimate the economic impact of introducing robotic-assisted surgery for spinal fusion procedures regardless of the indication from a Spanish, tertiary hospital perspective considering a 10-year time horizon.

METHODS: A cost analysis was developed based on previously published meta-analysis and a randomized clinical trial to assess the budget impact associated with replacing on a 1:1 basis conventional freehand surgery with robotic assisted surgery. Unit costs, obtained from different Spanish sources and expressed in €2023, were applied to health resource consumption comprising equipment, consumables, maintenance, surgical procedure, postoperative hospitalization, postoperative screw revisions and blood transfusions. Deterministic sensitivity analysis was performed to assess the robustness of the results.

RESULTS: For each treatment group, 300 procedures were considered annually over 10 years. Estimated mean total costs per patient undergoing robotic-assisted spine surgery or conventional freehand surgery were €13,650 and €13,922, respectively, resulting in mean total cost savings of €272 per patient. The acquisition cost of the robotic guidance system was outweighed by the cost savings associated with potential shorter length of stay, reduced need for revision procedures and blood transfusions, which resulted in a cost decrease per patient of €1,611, €372, and €58, respectively. These savings allowed a return on the capital investment from the sixth year following the intervention. As per the sensitivity analysis, the results were more sensitive to change in the hospitalization unit cost.

CONCLUSIONS: From a Spanish hospital perspective, upfront costs of performing robotic assisted spinal surgery for spinal fusion in comparison with conventional freehand surgery were estimated to be totally offset after the sixth year of investment.