Real-world hospital charges of robotic vs laparoscopic rectal surgery in a referral center in Japan: Cost breakdown analyses according to procedure

Background: Robotic surgery (RS) for rectal cancer has been widely spread since its charges have been applicable to health insurance system in Japan. The details of charges have not been fully investigated.
Methods: We analyzed hospitalization charges in 630 patients who underwent RS or laparoscopic surgery (LS) since April 2018 at our department (teaching hospital). Total and itemized charges were compared among different approaches and procedures.
Results: Overall, total hospital charge for RS (mean 2,179,815 yen) was higher than LS (mean 2,027,178 yen) because more expensive procedures were frequently performed via a robotic approach. They were similar figures to those in a report analyzing nationwide diagnostic procedure combination database in Japan. Anesthesia-related charge was higher in RS regardless of surgical procedure. The bundled per-diem payments by comprehensive assessment were higher in robotic high anterior resection (HAR). The relative ratio of total charge of RS to LS was lowest in abdominal perineal resection (APR, 0.898) followed by low anterior resection (LAR, 0.958), whereas it was 1.070 in HAR.
Conclusions: Robotic APR and LAR are recommended in terms of hospital charges. However, we must further consider the reduction in labor and equipment costs that are not included in the current analyses.