Opportunity Cost Analysis of Robotic Surgery

Several studies have established that a robotic surgical case, when compared to a conventional open procedure, adds approximately $3000/case to the hospital costs. The financial rationale for a robotic program depends on whether this extra cost “adds value” and yields a reasonable return on investment. Most often, the decision is justified by analyzing whether robotics improves patient recovery and avoids the costs of convalescence associated with open surgery. An opportunity cost analysis is an alternative method that is often used to elucidate the question of value. Using this financial framework, we directly compare the economic value of cardiac surgical robotics with the next best alternative, namely open chest surgery. For a hospital choosing not to adopt robotics, we identify domains where costs are avoided and domains in which a hospital might forgo value. Ultimately, our analysis of opportunity costs favors a robotics program. A hospital providing only open cardiac surgery and no robotics program forgoes more than $1 million in the first year, despite substantial start-up costs. After the first year, these costs are quickly offset by improvements in postoperative costs and other factors that increase reimbursements relative to open surgery. We speculate that hospitals to ignore the favorable opportunity costs of robotic surgery based on cognitive and emotional biases that tend to sway decisions toward conservative options. Increasing awareness of these biases will likely lead to better financial decisions about robotics.