Comparative Cost Analysis of Robotic Surgical Platforms: A Cost-Minimization and Break-Even Analysis for Prostatectomy
Year: 2026
Type: article
Abstract: Background/objectives: Robotic surgery has experienced rapid growth across multiple surgical specialties over the last two decades, with the da Vinci Surgical System emerging as a dominant global platform. Although robotic-assisted surgery (RAS) offers several technological advantages, including improved ergonomics, precision, and minimally invasive access, its widespread adoption remains constrained by high acquisition, maintenance, and consumable costs. Recently, new robotic platforms have entered the market with the aim of improving economic sustainability while maintaining comparable clinical outcomes. This study aimed to perform a comparative economic evaluation of three robotic surgical platforms currently used at ASST Grande Ospedale Metropolitano Niguarda Hospital, Milano, Italy: Da Vinci, Hugo™ RAS, and Versius®. Methods: Cost-minimization analysis (CMA), break-even analysis (BEA), and one-way deterministic sensitivity analysis (DSA) were conducted. Radical prostatectomy was selected as the reference procedure because of its high institutional volume and availability of published evidence. Cost estimates were derived from a combination of institutional real-world data and literature sources, including fixed costs (equipment acquisition and maintenance) and variable costs (robotic kits, operating room utilization, personnel, and hospitalization). Sensitivity analyses were performed by varying key cost drivers to assess their impact on economic sustainability. Results: Under the assumption of clinical equivalence among platforms, Hugo™ RAS demonstrated the lowest overall per-procedure cost (Euros [€]6,991.26), followed by Da Vinci (€7,839.51) and Versius® (€8,424.97). BEA showed that Hugo™ achieved cost recovery at approximately 124 procedures per year, compared with 161 procedures for Da Vinci and 208 procedures for Versius®. DSA identified the cost of the robotic kit, operative time, and hospitalization duration as the principal determinants of break-even variability across all platforms. Conclusions: Within the evaluated setting, Hugo™ RAS emerged as the most cost-efficient and economically sustainable robotic platform for radical prostatectomy. The findings highlight the importance of consumable costs, operative efficiency, and hospitalization management in determining the financial sustainability of robotic surgery programs. By integrating real-world evidence with economic modeling, this study provides useful information to support hospital decision makers in adopting and managing robotic surgical technologies.
Language: English
Subfield: Economics and Econometrics
Domain: Social Sciences
Open Access status: diamond
OpenAlex ID: W7214920792