A cost comparison between patients undergoing robotic colorectal surgery with and without a clinical pathway

BACKGROUND: Clinical pathways (CPs) are guidelines to standardize processes, improve quality of care and maximize resources through the implementation of evidence-based care for a medical procedure, thus reducing variation and risk. Our aim was to evaluate the cost of care for robotic colorectal surgery using a CP compared to surgery without a CP. METHODS: This was a non-interventional micro-costing study with a hospital-level perspective. It was carried out using the three standard steps. First, all resources involved in the implementation of the CP were identified. Second, resource consumption was measured. Third, the resources identified were valued and measured to estimate the average cost per group. This included the costs related to perioperative care and treatment of complications. Finally, a sensitivity analysis was conducted based on the hypothetical capacity utilization of the robotic equipment, costs of CP development and a discount rate of 3% over a period of five years. RESULTS: The study population comprised 63 patients: 21 in the CP group (robotic colorectal surgery with CP) and 42 in the no-CP group (robotic colorectal surgery without CP). The mean cost per patient in the CP group was €12,663 (range: €8,093 to €26,475), whereas in the no-CP group it was €11,128 (range: €8,357 to €17,268). The main cost drivers in the CP group were materials and disposables (33% of total costs) and staff (20% of total costs). In the no-CP group, they accounted for 38% and 20% of total costs, respectively. The CP group was used for the sensitivity analysis. In year 1, at 100% utilization the mean cost per patient was €12,364, increasing to €17,883 at 20% utilization. In year 5, at 100% utilization the mean cost per patient was €13,986, rising to €20,519 at 20% utilization. CONCLUSION: The evidence from our study indicates that using a CP for perioperative care of patients undergoing robotic colorectal surgery was not associated with a statistically significant reduction in cost of care.