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Iachecen F, Dallagassa MR, Portela Santos EA, Carvalho DR, Ioshii SO. Is it possible to automate the discovery of process maps for the time-driven activity-based costing method? A systematic review. BMC Health Serv Res 2023; 23:1408. [PMID: 38093275 PMCID: PMC10720189 DOI: 10.1186/s12913-023-10411-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 11/30/2023] [Indexed: 12/17/2023] Open
Abstract
OBJECTIVES The main objective of this manuscript was to identify the methods used to create process maps for care pathways that utilized the time-driven activity-based costing method. METHODS This is a systematic mapping review. Searches were performed in the Embase, PubMed, CINAHL, Scopus, and Web of Science electronic literature databases from 2004 to September 25, 2022. The included studies reported practical cases from healthcare institutions in all medical fields as long as the time-driven activity-based costing method was employed. We used the time-driven activity-based costing method and analyzed the created process maps and a qualitative approach to identify the main fields. RESULTS A total of 412 studies were retrieved, and 70 articles were included. Most of the articles are related to the fields of orthopedics and childbirth-related to hospital surgical procedures. We also identified various studies in the field of oncology and telemedicine services. The main methods for creating the process maps were direct observational practices, complemented by the involvement of multidisciplinary teams through surveys and interviews. Only 33% of the studies used hospital documents or healthcare data records to integrate with the process maps, and in 67% of the studies, the created maps were not validated by specialists. CONCLUSIONS The application of process mining techniques effectively automates models generated through clinical pathways. They are applied to the time-driven activity-based costing method, making the process more agile and contributing to the visualization of high degrees of variations encountered in processes, thereby making it possible to enhance and achieve continual improvements in processes.
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Affiliation(s)
- Franciele Iachecen
- Graduate Program in Health Technology, Pontifícia Universidade Católica do Paraná., 1155, Imaculada Conceição st., Curitiba, Paraná, 80215-90, Brazil.
| | - Marcelo Rosano Dallagassa
- Graduate Program in Health Technology, Pontifícia Universidade Católica do Paraná., 1155, Imaculada Conceição st., Curitiba, Paraná, 80215-90, Brazil
| | | | - Deborah Ribeiro Carvalho
- Graduate Program in Health Technology, Pontifícia Universidade Católica do Paraná., 1155, Imaculada Conceição st., Curitiba, Paraná, 80215-90, Brazil
| | - Sérgio Ossamu Ioshii
- Graduate Program in Health Technology, Pontifícia Universidade Católica do Paraná., 1155, Imaculada Conceição st., Curitiba, Paraná, 80215-90, Brazil
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Sadri H, Fung-Kee-Fung M, Shayegan B, Garneau PY, Pezeshki P. A systematic review of full economic evaluations of robotic-assisted surgery in thoracic and abdominopelvic procedures. J Robot Surg 2023; 17:2671-2685. [PMID: 37843673 PMCID: PMC10678817 DOI: 10.1007/s11701-023-01731-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 09/24/2023] [Indexed: 10/17/2023]
Abstract
This study aims to conduct a systematic review of full economic analyses of robotic-assisted surgery (RAS) in adults' thoracic and abdominopelvic indications. Authors used Medline, EMBASE, and PubMed to conduct a systematic review following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) 2020 guidelines. Fully published economic articles in English were included. Methodology and reporting quality were assessed using standardized tools. Majority of studies (28/33) were on oncology procedures. Radical prostatectomy was the most reported procedure (16/33). Twenty-eight studies used quality-adjusted life years, and five used complication rates as outcomes. Nine used primary and 24 studies used secondary data. All studies used modeling. In 81% of studies (27/33), RAS was cost-effective or potentially cost-effective compared to comparator procedures, including radical prostatectomy, nephrectomy, and cystectomy. Societal perspective, longer-term time-horizon, and larger volumes favored RAS. Cost-drivers were length of stay and equipment cost. From societal and payer perspectives, robotic-assisted surgery is a cost-effective strategy for thoracic and abdominopelvic procedures.Clinical trial registration This study is a systematic review with no intervention, not a clinical trial.
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Affiliation(s)
- Hamid Sadri
- Department of Health Economic and Outcomes Research, Medtronic ULC, 99 Hereford St., Brampton, ON, L6Y 0R3, Canada.
| | - Michael Fung-Kee-Fung
- Champlain Regional Cancer Program Depts OB/GYN, Surgery, The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
| | - Bobby Shayegan
- Division of Urology, Department of Surgery, McMaster University, 50 Charlton Ave., Hamilton, ON, L8N 4A6, Canada
| | - Pierre Y Garneau
- Surgical Department, Hôpital du Sacré-Coeur de Montréal, 5400 Boul Gouin O, Montréal, QC, H4J 1C5, Canada
| | - Padina Pezeshki
- Department of Clinical Research, Medtronic ULC, 99 Hereford St., Brampton, ON, L6Y 0R3, Canada
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Song C, Cheng L, Li Y, Kreaden U, Snyder SR. Systematic literature review of cost-effectiveness analyses of robotic-assisted radical prostatectomy for localised prostate cancer. BMJ Open 2022; 12:e058394. [PMID: 36127082 PMCID: PMC9490571 DOI: 10.1136/bmjopen-2021-058394] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Review and assess cost-effectiveness studies of robotic-assisted radical prostatectomy (RARP) for localised prostate cancer compared with open radical prostatectomy (ORP) and laparoscopic radical prostatectomy (LRP). DESIGN Systematic review. SETTING PubMed, Embase, Scopus, International HTA database, the Centre for Reviews and Dissemination database and various HTA websites were searched (January 2005 to March 2021) to identify the eligible cost-effectiveness studies. PARTICIPANTS Cost-effectiveness, cost-utility, or cost-minimization analyses examining RARP versus ORP or LRP were included in this systematic review. INTERVENTIONS Different surgical approaches to treat localized prostate cancer: RARP compared with ORP and LRP. PRIMARY AND SECONDARY OUTCOME MEASURES A structured narrative synthesis was developed to summarize results of cost, effectiveness, and cost-effectiveness results (eg, incremental cost-effectiveness ratio [ICER]). Study quality was assessed using the Consensus on Health Economic Criteria Extended checklist. Application of medical device features were evaluated. RESULTS Twelve studies met inclusion criteria, 11 of which were cost-utility analyses. Higher quality-adjusted life-years and higher costs were observed with RARP compared with ORP or LRP in 11 studies (91%). Among four studies comparing RARP with LRP, three reported RARP was dominant or cost-effective. Among ten studies comparing RARP with ORP, RARP was more cost-effective in five, not cost-effective in two, and inconclusive in three studies. Studies with longer time horizons tended to report favorable cost-effectiveness results for RARP. Nine studies (75%) were rated of moderate or good quality. Recommended medical device features were addressed to varying degrees within the literature as follows: capital investment included in most studies, dynamic pricing considered in about half, and learning curve and incremental innovation were poorly addressed. CONCLUSIONS Despite study heterogeneity, RARP was more costly and effective compared with ORP and LRP in most studies and likely to be more cost-effective, particularly over a multiple year or lifetime time horizon. Further cost-effectiveness analyses for RARP that more thoroughly consider medical device features and use an appropriate time horizon are needed. PROSPERO REGISTRATION NUMBER CRD42021246811.
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Affiliation(s)
- Chao Song
- Global Health Economics and Outcome Research, Intuitive Surgical, Atlanta, GA, USA
| | - Lucia Cheng
- Global Health Economics and Outcome Research, Intuitive Surgical, Sunnyvale, CA, USA
| | - Yanli Li
- Global Health Economics and Outcome Research, Intuitive Surgical, Sunnyvale, CA, USA
| | - Usha Kreaden
- Biostatistics & Global Evidence Management, Intuitive Surgical, Sunnyvale, CA, USA
| | - Susan R Snyder
- Georgia State University School of Public Health, Atlanta, Georgia, USA
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Jimenez C, Stanton E, Sung C, Wong AK. Does plastic surgery need a rewiring? A survey and systematic review on robotic-assisted surgery. JPRAS Open 2022; 33:76-91. [PMID: 35812356 PMCID: PMC9260262 DOI: 10.1016/j.jpra.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 05/11/2022] [Indexed: 01/28/2023] Open
Abstract
Background This is a paucity of data regarding plastic surgeons' opinions on robotic-assisted surgery (RAS). We developed a questionnaire aimed to survey plastic surgeons regarding training in robotics, concerns about widespread implementation, and new research directions. Methods A survey was created using Google Forms and sent to practicing plastic surgeons and trainees. Responses regarding desired conference proceedings about robotics, robotic residency training, and perceived barriers to implementation were elicited. Survey responses were utilized to direct a systematic review on RAS in plastic surgery. Results The survey received 184 responses (20.4%; 184/900). The majority (92.8%) of respondents were/are plastic surgery residents, with the most common fellowships being microsurgery (39.2%). Overall, 89.7% of respondents support some integration of robotics in the future of plastic surgery, particularly in pelvic/perineum reconstruction (56.4%), abdominal reconstruction (46.5%), microsurgery (43.6%), and supermicrosurgery (44.2%). Many respondents (66.1%) report never using a robot in their careers. Respondents expressed notable barriers to widespread robotic implementation, with cost (73.0%) serving as the greatest obstacle. A total of 10 studies (pelvic/perineum = 3; abdominal = 3; microsurgery = 4) were included after full-text review. Conclusions Evidence from our survey and review supports the growing interest and utility of RAS within the plastic and reconstructive surgery (PRS) and mirrors the established trend in other surgical subspecialties. Cost analyses will prove critical to implementing RAS within PRS. With validated benefits, plastic surgery programs can begin creating dedicated curricula for RAS.
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Affiliation(s)
- Christian Jimenez
- Keck School of Medicine of USC, Los Angeles, CA,Division of Plastic and Reconstructive Surgery, Keck School of Medicine, Los Angeles, CA
| | - Eloise Stanton
- Keck School of Medicine of USC, Los Angeles, CA,Division of Plastic and Reconstructive Surgery, Keck School of Medicine, Los Angeles, CA
| | - Cynthia Sung
- Keck School of Medicine of USC, Los Angeles, CA,Division of Plastic and Reconstructive Surgery, Keck School of Medicine, Los Angeles, CA,Division of Plastic and Reconstructive Surgery, City of Hope National Medical Center, Duarte, CA
| | - Alex K. Wong
- Keck School of Medicine of USC, Los Angeles, CA,Division of Plastic and Reconstructive Surgery, Keck School of Medicine, Los Angeles, CA,Division of Plastic and Reconstructive Surgery, City of Hope National Medical Center, Duarte, CA,Corresponding author: Alex K. Wong, Division of Plastic and Reconstructive Surgery, City of Hope, 1500 E Duarte Rd, Duarte, CA 91010.
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Labban M, Dasgupta P, Song C, Becker R, Li Y, Kreaden US, Trinh QD. Cost-effectiveness of Robotic-Assisted Radical Prostatectomy for Localized Prostate Cancer in the UK. JAMA Netw Open 2022; 5:e225740. [PMID: 35377424 PMCID: PMC8980901 DOI: 10.1001/jamanetworkopen.2022.5740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE The cost-effectiveness of different surgical techniques for radical prostatectomy remains a subject of debate. Emergence of recent critical clinical data and changes in surgical equipment costs due to their shared use by different clinical specialties necessitate an updated cost-effectiveness analysis in a centralized, largely government-funded health care system such as the UK National Health Service (NHS). OBJECTIVE To compare robotic-assisted radical prostatectomy (RARP) with open radical prostatectomy (ORP) and laparoscopic-assisted radical prostatectomy (LRP) using contemporary data on clinical outcomes, costs, and surgical volumes in the UK. DESIGN, SETTING, AND PARTICIPANTS This economic analysis used a Markov model developed to compare the cost-effectiveness of RARP, LRP, and ORP to treat localized prostate cancer. The model was constructed from the perspective of the UK NHS. The model simulated 65-year-old men who underwent radical prostatectomy for localized prostate cancer and were followed up for a 10-year period. Data were analyzed from May 1, 2020, to July 31, 2021. EXPOSURES Robotic-assisted radical prostatectomy, LRP, and ORP. MAIN OUTCOMES AND MEASURES Quality-adjusted life-years (QALYs), costs (direct medical costs and costs outside the NHS), and incremental cost-effectiveness ratios (ICERs). RESULTS Compared with LRP, RARP cost £1785 (US $2350) less and had 0.24 more QALYs gained; thus, RARP was a dominant option compared with LRP. Compared with ORP, RARP had 0.12 more QALYs gained but cost £526 (US $693) more during the 10-year time frame, resulting in an ICER of £4293 (US $5653)/QALY. Because the ICER was below the £30 000 (US $39 503) willingness-to-pay threshold, RARP was more cost-effective than ORP in the UK. The most sensitive variable influencing the cost-effectiveness of RARP was the lower risk of biochemical recurrence (BCR). Scenario analysis indicated RARP would remain more cost-effective than ORP as long as the BCR hazard ratios comparing RARP vs ORP were less than 0.99. CONCLUSIONS AND RELEVANCE These findings suggest that in the UK, RARP has an ICER lower than the willingness-to-pay threshold and thus is likely a cost-effective surgical treatment option for patients with localized prostate cancer compared with ORP and LRP. The results were mainly driven by the lower risk of BCR for RARP. These findings may differ in other health care settings where different thresholds and costs may apply.
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Affiliation(s)
- Muhieddine Labban
- Division of Urological Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Prokar Dasgupta
- MRC (Medical Research Council) Centre for Transplantation, Guy’s Hospital Campus, King’s College London, King’s Health Partners, London, United Kingdom
| | - Chao Song
- Global Health Economics and Outcome Research, Intuitive Surgical Inc, Atlanta, Georgia
| | | | - Yanli Li
- Global Health Economics and Outcome Research, Intuitive Surgical Inc, Sunnyvale, California
| | - Usha Seshadri Kreaden
- Biostatistics & Global Evidence Management, Intuitive Surgical Inc, Sunnyvale, California
| | - Quoc-Dien Trinh
- Division of Urological Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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Küper MA, Trulson A, Johannink J, Hirt B, Leis A, Hoßfeld M, Histing T, Herath SC, Amend B. Robotic-assisted plate osteosynthesis of the anterior pelvic ring and acetabulum: an anatomical feasibility study. J Robot Surg 2022; 16:1401-1407. [PMID: 35147842 DOI: 10.1007/s11701-022-01381-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 01/29/2022] [Indexed: 11/26/2022]
Abstract
Pelvic ring injuries or acetabular fractures present a challenge to trauma surgeons. Recently, endoscopic dissection techniques for visualization of the anterior pelvic ring and acetabulum have been presented. Robotic-assisted surgical systems offer advantages in terms of improved visualization and easier instrument handling. The aim of this pilot anatomic study was to verify the feasibility of robotic-assisted plate osteosynthesis on the anterior pelvic ring and acetabulum. The experiment was performed on a human whole body specimen. The DaVinci system with standard instruments as used in RARP was used. After docking the system, the anterior pelvic ring was first prepared as previously described for the endoscopic techniques. This was followed by dissection of both acetabula analogous to pelvic lymphadenectomy as performed during RARP. After the dissection was performed along the pelvic brim up to the iliosacral joint, the complete anterior column of the acetabulum including quadrilateral surface and incisura ischiadica major could be visualized. Finally, robotic-assisted endoscopic plate osteosynthesis was performed on the symphysis and anterior acetabular column as previously described in the endoscopic techniques. Robotic-assisted plate osteosynthesis of the anterior pelvic ring and acetabulum is feasible with the available robotic-assisted systems. Due to the excellent freedom of movement of the robotic arms, combined with the magnifying 3D visualization of the system, highly accurate preparation of the situs in preparation for plate osteosynthesis can be performed. The question of reduction of dislocated fractures remains open and is the subject of further investigation. Compared with conventional laparoscopy, robotic-assisted preparation nevertheless appears to offer an advantage in view of the complexity of the operation.
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Affiliation(s)
- Markus A Küper
- Department for Traumatology and Reconstructive Surgery, BG Trauma Center, University of Tübingen, Schnarrenbergstraße 95, 72076, Tübingen, Germany.
| | - Alexander Trulson
- Department for Traumatology, Orthopedics and Surgery, BG Trauma Center, Murnau am Staffelsee, Germany
| | - Jonas Johannink
- Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany
| | - Bernhard Hirt
- Institute of Clinical Anatomy and Cell Analysis, University of Tübingen, Tübingen, Germany
| | - Artur Leis
- Institut für Strahlwerkzeuge (IFSW), University of Stuttgart, Stuttgart, Germany
| | - Max Hoßfeld
- Institut für Strahlwerkzeuge (IFSW), University of Stuttgart, Stuttgart, Germany
| | - Tina Histing
- Department for Traumatology and Reconstructive Surgery, BG Trauma Center, University of Tübingen, Schnarrenbergstraße 95, 72076, Tübingen, Germany
| | - Steven C Herath
- Department for Traumatology and Reconstructive Surgery, BG Trauma Center, University of Tübingen, Schnarrenbergstraße 95, 72076, Tübingen, Germany
| | - Bastian Amend
- Department for Urology, University Hospital Tübingen, Tübingen, Germany
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