Budget impact analysis of robot-assisted versus conventional spine surgery in Spain

Robot-assisted spine surgery (RASS) enhances procedural accuracy and reproducibility by ensuring full adherence to preoperative surgical plans. However, its widespread adoption remains limited by the need for a substantial upfront investment. In this study, the economic impact of spinal procedures performed under the guidance of the Mazor™ robotic system was compared with that of conventional techniques from an advanced Spanish hospital perspective. A 10-year budget impact analysis was conducted. The target population included all spinal surgeries potentially suitable for robot assistance, estimated from published data and expert input. Two scenarios were compared: a baseline scenario without Mazor™ and a progressive Mazor™ adoption scenario. Unit costs (€, 2025), obtained from Spanish sources, were applied to components of health care resource consumption. Model inputs and assumptions were validated by a panel of Spanish experts. A deterministic one-way sensitivity analysis (OWSA) was performed to assess the robustness of the results. The number of RASS-eligible patients increased from 213 to 330 annually over 10 years (2,673 total). The mean cost per patient was €10,093 for conventional surgery and €9,082 for RASS, generating average savings of €1,011 per patient. Savings were driven mainly by reductions in the length of hospital stay (€1,523), revision surgeries (€793), and complications (€261), outweighing the Mazor™ acquisition cost. Over the 10-year horizon, cumulative savings reached €2.54 million, achieving full capital investment recovery within 3.83 years. OWSA confirmed the robustness of these findings. From an advanced Spanish hospital perspective, the initial investment in RASS is recouped within four years, supporting its financial sustainability and long-term economic advantage over conventional spinal surgery.