A cost analysis of robotic lung resection versus stereotactic radiosurgery

Background: Robotic lung resection (RLR) and stereotactic body radiation therapy (SBRT) are the most common treatments for clinical stage I cancer and oligometastatic disease of the lung. The relative costs of these two modalities are not well described. This study aims to compare the direct costs of RLR versus SBRT. Methods: This study was a single institution, retrospective analysis of the cost of performing RLR versus the cost of performing SBRT. We used electronic medical record data from procedures dating from January 2017 to December 2018. We examined direct costs of RLR and SBRT. For RLR, this included the surgery and all direct costs associated with the index hospitalization and hospital costs within 30 days following lung resection. For SBRT, this included the costs of simulation, planning, and delivery of SBRT, as well as the cost of navigational bronchoscopy with fiducial marker placement. Indirect/overhead costs (i.e., depreciation and amortization of surgical robotic and radiosurgery systems) were excluded from this study. Follow-up clinic visits, radiologic surveillance, and costs incurred more than 30 days after RLR or related to post-SBRT complications were not included in the analysis. To calculate the average cost per patient, the total of all direct costs was divided by the total number of patients. Results: Costs were analyzed for 103 RLR patients and 101 SBRT patients (N=204). The median length of stay for RLR was 2 days. The average direct cost of RLR ($12,197) was 36% greater than the average direct cost of SBRT ($8,933). The two most expensive components of RLR were the surgery itself ($6,591/patient) and intense care unit (ICU) stay ($9,241/patient). The two most expensive costs for SBRT were radiation oncology ($5,032) and fiducial marker placement ($3,901). ICU admission substantially increases the cost of RLR (an average of $7,171 per patient if ICU care is needed). Conclusions: The average initial cost of RLR is higher than SBRT per patient.