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. 2018 Apr 20;24(2):73-80.
doi: 10.5761/atcs.oa.17-00094. Epub 2018 Jan 17.

Cost-Benefit Performance Simulation of Robot-Assisted Thoracic Surgery As Required for Financial Viability under the 2016 Revised Reimbursement Paradigm of the Japanese National Health Insurance System

Naohiro Kajiwara  1   2 , Yasufumi Kato  1 , Masaru Hagiwara  1 , Masatoshi Kakihana  1 , Tatsuo Ohira  1 , Norihiko Kawate  2 , Norihiko Ikeda  1
Affiliations

Cost-Benefit Performance Simulation of Robot-Assisted Thoracic Surgery As Required for Financial Viability under the 2016 Revised Reimbursement Paradigm of the Japanese National Health Insurance System

Naohiro Kajiwara et al. Ann Thorac Cardiovasc Surg. .

Abstract

Purpose: To discuss the cost-benefit performance (CBP) and establish a medical fee system for robotic-assisted thoracic surgery (RATS) under the Japanese National Health Insurance System (JNHIS), which is a system not yet firmly established.

Methods: All management steps for RATS are identical, such as preoperative and postoperative management. This study examines the CBP based on medical fees of RATS under the JNHIS introduced in 2016.

Results: Robotic-assisted laparoscopic prostatectomy (RALP) and robotic-assisted partial nephrectomy (RAPN) now receive insurance reimbursement under the category of use of support devices for endoscopic surgery ($5420 and $3485, respectively). If the same standard amount were to be applied to RATS, institutions would need to perform at least 150 or 300 procedures thoracic operation per year to show a positive CBP ($317 per procedure as same of RALP and $130 per procedure as same of RAPN, respectively).

Conclusion: Robotic surgery in some areas receives insurance reimbursement for its "supportive" use for endoscopic surgery as for RALP and RAPN. However, at present, it is necessary to perform da Vinci Surgical System Si (dVSi) surgery at least 150-300 times in a year in a given institution to prevent a deficit in income.

Keywords: Japanese National Health Insurance System; cost–benefit performance; da Vinci Surgical System; robot-assisted thoracic surgery.

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Figures

Fig. 1
Fig. 1. Cost of extended thymectomy with myasthenia gravis among open thoracotomy, VATS and RATS procedures. The financial differences are shown among institutions performing RATS procedures, in which institutions performed the dVSi operation 100, 150, 200, or 300 times per year. Figures are based on data contained in Tables 1, 2, and 3. Since the purchase price and 5-year service life cost are set by the government, the cost per RATS procedure in the institution obviously decreases with the number of procedures performed annually. MG: myasthenia gravis; VATS: video-assisted thoracic surgery; RATS: robotic-assisted thoracic surgery; dVSi: da Vinci Surgical System Si; RALP: robotic-assisted laparoscopic prostatectomy; RAPN: robotic-assisted partial nephrectomy
Fig. 2
Fig. 2. Cost of pulmonary lobectomy for malignant disease among open thoracotomy, VATS and RATS procedures, in institutions which performed the dVSi operation 100, 150, 200, or 300 times in a year. Figures are based on data contained in Tables 1, 2, and 3. dVSi: da Vinci Surgical System Si; VATS: video-assisted thoracic surgery; RATS: robotic-assisted thoracic surgery; RALP: robotic-assisted laparoscopic prostatectomy; RAPN: robotic-assisted partial nephrectomy
See this image and copyright information in PMC

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