March 10, 2011

If you build it, they will come. Buy robots & the surgery will be done.

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A paper in the journal Medical Care concludes that hospitals that acquire surgical robots do more radical prostatectomies as a result – an average of 29 more per year – while those without robots actually did fewer radical prostatectomies. Their conclusion:

“Policy makers must recognize the intimate association between technology diffusion and procedure utilization when approving costly new medical devices with unproven benefit.”

In a news release, the lead author said:

“The use of the surgical robot to treat prostate cancer is an instructive example of an expensive medical technology becoming rapidly adopted without clear proof of its benefit,” said Danil V. Makarov, MD, MHS, assistant professor, Department of Urology at NYU Langone Medical Center and assistant professor of Health Policy at NYU Wagner School of Public Health. “Policymakers must carefully consider what the added-value is of costly new medical devices, because, once approved, they will most certainly be used.”

“Patients should be aware that if they seek care at a hospital with a new piece of surgical technology, they may be more likely to have surgery and should inquire about its risks as well as its benefits,” said Dr. Makarov. “Hospitals administrators should also consider that new technology may increase surgical volume, but this increase may not be sufficient to compensate for its cost.”

Addendum: Here’s the New York Times column on this study, posted a day later.

Comments (6)

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Gregory D. Pawelski

March 11, 2011 at 11:10 am

Research from a couple of years ago (October 12, 2009 issue of JAMA) indicated that the use of minimally invasive procedures (including the use of robotic assistance) for radical prostatectomy may shorten hospital stays and decrease respiratroy and surgical complications, but may also result in an increased rate of certain complications, including incontinence and erectile dysfunction.
Minimally invasive radical prostatectomy (MIRP), in particular with the use of robotic assistance, has increased from 1% to 40% of all radical prostatectomies from 2001 to 2006, according to background information in the article. But this rapid increase has occurred despite limited data on outcomes and greater costs compared with open retropubic radical prostatectomy (surgery in which an incision is made in the lower abdomen to remove the prostate, which is located in the pelvis behind the pubic bone).
The authors wrote, “moreover, the widespread direct-to-consumer advertising and marketed benefits of robotic-assisted MIRP in the United States may promote publication bias against studies that detail challenges and suboptimal outcomes early in the MIRP learning curve. Until comparative effectiveness of robotic-assisted MIRP can be demonstrated, open RRP, with a 20-year lead time for dissemination of surgical technique relative to MIRP, remains the gold standard surgical therapy for localized prostate cancer.”
The researchers also found that greater receipt of MIRP vs. RRP was associated with living in areas of higher socioeconomic status based on education and income, and that this may be the result of a “highly successful robotic-assisted MIRP marketing campaign disseminated via the Internet, radio, and print media channels likely to be frequented by men of higher socioeconomic status.”
“In light of the mixed outcomes associated with MIRP, our finding that men of higher socioeconomic status opted for a high-technology alternative despite insufficient data demonstrating superiority over an established gold standard may be a reflection of a society and health care system enamored with new technology that increased direct and indirect health care costs but had yet to uniformly realize marketed or potential benefits during early adoption,” the authors conclude.

Chris

March 11, 2011 at 3:50 pm

I’m waiting for the splashy national headlines claiming:
NEW EXPENSIVE HI-TECH TREATMENT FOR PROSTATE CANCER PROVES EQUAL TO DOING NOTHING: DOCTORS, HOSPITALS AND PATIENTS INSIST COST “WORTH IT”

EBMResearch

March 18, 2011 at 2:30 pm

Another article (N Engl J Med 2010; 363:701-704) regarding the cost associated with robotic-assisted surgery was published last year by Barbash and Glied (2010) in NEJM. The article supports the Hayes, Inc. assessments that “current evidence fails to demonstrate superior health outcomes for robotic procedures compared with other surgical techniques.”
http://www.hayesinc.com/hayes/concerns-about-rapid-adoption-of-robotic-technology/

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