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Robotic-assisted surgery for prostatectomy – does the diffusion of robotic systems contribute to treatment centralization and influence patients’ hospital choice?

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Listed:
  • David Kuklinski

    (University of St. Gallen)

  • Justus Vogel

    (University of St. Gallen)

  • Cornelia Henschke

    (Berlin University of Technology, Berlin Centre of Health Economics Research)

  • Christoph Pross

    (Berlin University of Technology)

  • Alexander Geissler

    (University of St. Gallen)

Abstract

Background Between 2008 and 2018, the share of robotic-assisted surgeries (RAS) for radical prostatectomies (RPEs) has increased from 3 to 46% in Germany. Firstly, we investigate if this diffusion of RAS has contributed to RPE treatment centralization. Secondly, we analyze if a hospital’s use of an RAS system influenced patients’ hospital choice. Methods To analyze RPE treatment centralization, we use (bi-) annual hospital data from 2006 to 2018 for all German hospitals in a panel-data fixed effect model. For investigating RAS systems’ influence on patients’ hospital choice, we use patient level data of 4614 RPE patients treated in 2015. Employing a random utility choice model, we estimate the influence of RAS as well as specialization and quality on patients’ marginal utilities and their according willingness to travel. Results Despite a slight decrease in RPEs between 2006 and 2018, hospitals that invested in an RAS system could increase their case volumes significantly (+ 82% compared to hospitals that did not invest) contributing to treatment centralization. Moreover, patients are willing to travel longer for hospitals offering RAS (+ 22% than average travel time) and for specialization (+ 13% for certified prostate cancer treatment centers, + 9% for higher procedure volume). The influence of outcome quality and service quality on patients’ hospital choice is insignificant or negligible. Conclusions In conclusion, centralization is partly driven by (very) high-volume hospitals’ investment in RAS systems and patient preferences. While outcome quality might improve due to centralization and according specialization, evidence for a direct positive influence of RAS on RPE outcomes still is ambiguous. Patients have been voting with their feet, but research yet has to catch up.

Suggested Citation

  • David Kuklinski & Justus Vogel & Cornelia Henschke & Christoph Pross & Alexander Geissler, 2023. "Robotic-assisted surgery for prostatectomy – does the diffusion of robotic systems contribute to treatment centralization and influence patients’ hospital choice?," Health Economics Review, Springer, vol. 13(1), pages 1-16, December.
    • Handle: RePEc:spr:hecrev:v:13:y:2023:i:1:d:10.1186_s13561-023-00444-9
    DOI: 10.1186/s13561-023-00444-9
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