Efficiency and productivity gains of robotic surgery: the case of the English National Health Service

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• dc.contributor.author Maynou Pujolràs, Laia
• dc.contributor.author McGuire, Alistair
• dc.contributor.author Serra-Sastre, Victoria
• dc.date.accessioned 2024-10-14T09:47:33Z
• dc.date.available 2024-10-14T09:47:33Z
• dc.date.issued 2024
• dc.description Includes supplementary materials for the online appendix.
• dc.description.abstract This paper examines the effect of new medical technology (robotic surgery) on efficiency gains and productivity changes for surgical treatment in patients with prostate cancer from the perspective of a public health sector organization. In particular, we consider three interrelated surgical technologies within the English National Health System: robotic, laparoscopic and open radical prostatectomy. Robotic and laparoscopic techniques are minimally invasive procedures with similar clinical benefits. While the clinical benefits in adopting robotic surgery over laparoscopic intervention are unproven, it requires a high initial investment cost and carries high on-going maintenance costs. Using data from Hospital Episode Statistics for the period 2000–2018, we observe growing volumes of prostatectomies over time, mostly driven by an increase in robotic-assisted surgeries, and further analyze whether hospital providers that adopted a robot see improved measures of throughput. We then quantify changes in total factor and labor productivity arising from the use of this technology. We examine the impact of robotic adoption on efficiency gains employing a staggered difference-in-difference estimator and find evidence of a 50% reduction in length of stay (LoS), 49% decrease in post-LoS and 44% and 46% decrease in postoperative visits after 1 year and 2 years, respectively. Productivity analysis shows the growth in radical prostatectomy volume is sustained with a relatively stable number of urology surgeons. The robotic technique increases total production at the hospital level between 21% and 26%, coupled with a 29% improvement in labor productivity. These benefits lend some, but not overwhelming support for the large-scale hospital investments in such costly technology.
• dc.description.sponsorship This paper was produced using HES provided by NHS Digital under Data Sharing Agreement (DSA) NIC-354497-V2J9P. This paper has been screened to ensure no confidential information is revealed. We thank Georgia Pearson for her work in a preliminary work of this study. We thank participants at Jornadas AES organized by the Asociación Espanola Economía de la Salud where a preliminary version of this paper was awarded with the best paper presented by a young researcher, VIII Taller EvaluAES, Department Health Policy Seminar Series LSE, Departament d’Economia Aplicada, Universitat Autónoma de Barcelona, London Health Economists' Study Group seminar, Departament d’Economia, Universitat Rovira i Virgili, NHS Improvement seminar and comments received by the Advisory Committee of the Efficiency Research Program. We also thank colleagues at the LSE, in particular Guy Michaels and John Van Reenen for their comments. This work was supported by the Efficiency Research Program funded by The Health Foundation, Award Reference Number 7432. Laia Maynou is funded by the Spanish Ministry of Science, Innovation and Universities (PID2022-138866OB-I00 and CNS2023-144351).
• dc.format.mimetype application/pdf
• dc.identifier.citation Maynou L, McGuire A, Serra‐Sastre V. Efficiency and productivity gains of robotic surgery: the case of the English National Health Service. Health Econ. 2024 Aug;33(8):1831-56. DOI: 10.1002/hec.4838
• dc.identifier.doi http://dx.doi.org/10.1002/hec.4838
• dc.identifier.issn 1057-9230
• dc.identifier.uri http://hdl.handle.net/10230/61385
• dc.language.iso eng
• dc.publisher Wiley
• dc.relation.ispartof Health Economics. 2024 Aug;33(8):1831-56
• dc.relation.projectID info:eu-repo/grantAgreement/ES/2PE/PID2022-138866OB-I00
• dc.relation.projectID info:eu-repo/grantAgreement/ES/3PE/CNS2023-144351
• dc.rights © 2024 The Authors. Health Economics published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
• dc.rights.accessRights info:eu-repo/semantics/openAccess
• dc.rights.uri http://creativecommons.org/licenses/by-nc-nd/4.0/
• dc.subject.keyword Efficiency gains
• dc.subject.keyword Labor productivity
• dc.subject.keyword Robotic surgery
• dc.subject.keyword Staggered difference-in-differences
• dc.subject.keyword Total factor productivity
• dc.title Efficiency and productivity gains of robotic surgery: the case of the English National Health Service
• dc.type info:eu-repo/semantics/article
• dc.type.version info:eu-repo/semantics/publishedVersion