Economics of robotics in urology

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Abstract
New technologies such as robotics are constantly introduced clinically without a complete understanding of benefits and costs. In order for urologists to optimize their care of patients, there is a need to understand the economic factors that impact on their ability to practice medicine. This review will discuss general concepts of health economics and apply them to the application of robotics to urologic procedures. Utilization of robotic surgery, especially for robotic-assisted laparoscopic prostatectomy, has increased dramatically in recent years. The robot adds significant costs in terms of acquisition, maintenance, and daily instrument costs. These added costs, thus far, have not been associated with significant improvement in outcomes over 'pure' laparoscopy or open procedures. In order for the robot to be cost-effective, efficacy needs to be improved over alternative approaches and costs of the robot or instrumentation needs to be decreased. Robotic application is not cost-effective compared with open or laparoscopic approaches and future studies will need to determine whether there are indirect benefits that will justify its use.