The Effects of Surgical Approaches and Enhanced Recovery Protocols on the Cost Effectiveness of Radical Cystectomy

Eyal Kord*, Moshe Leshno, Miki Haifler

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Enhanced recovery protocols and robotic approaches to radical cystectomy are known to reduce perioperative complications; however, the most cost-effective strategy is unknown. We aim to assess the cost effectiveness of radical cystectomy with different surgical techniques and perioperative treatment protocols. We performed a meta-analysis of studies comparing open radical cystectomy (ORC), robotic assisted radical cystectomy (RARC) using extracorporeal (ECUD) or intracorporeal urinary diversion (ICUD) and enhanced recovery after surgery (ERAS) protocols. Operative time, transfusion, complication, Ileus, length of stay and re-admission rates were extracted. US costs for surgery, treatment, hospitalization and complications were obtained from the literature. Israeli costs were obtained from hospital administrative data. Two cost effectiveness models (US and Israel) were developed. The two most cost-effective strategies in both models were ORC with ERAS and RARC with ICUD and ERAS. RARC with ERAS produced the two most effective strategies with ICUD being dominant over ECUD. All strategies implementing the ERAS protocol were more effective than their parallel non-ERAS strategies. RARC with ICUD and ERAS is cost effective compared to ORC. ERAS protocol improves treatment effectiveness and lowers overall costs. ICUD was shown to be more effective and less costly in comparison to ECUD.

Original languageEnglish
Article number1433
JournalJournal of Personalized Medicine
Issue number9
StatePublished - Sep 2022


  • cost effectiveness
  • enhanced recovery protocol
  • radical cystectomy
  • robotic surgery
  • urinary diversion


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