Insurer no longer covering Da Vinci

My insurance company here in Hollnad made the news yesterday as it has announced that as from 1st Jan 2012 it will no longer be covering all the costs of Da Vinci surgery.
nos.nl/artikel/321675-achmea-stopt-extra-vergoeding-robot.html
Their reasoning seems to be that a study by the College of Health Insurers has shown that there is no clear benefit from using the robot as compared to normal laparoscopic or open surgery. They are also concerned that too many hospitals have bought too many Da Vinci machines and they are not being used effectively, some apparently only get used a few days a week. They reckon that the country only needs 4 machines, but there are now 16. (Approx 1200 RALPs are carried out per year). They seem to be saying that the incorrect use of the Da Vinci is pushing up costs for the wrong reasons. From January they will therefore only cover the costs of conventional surgery. Patients should however not notice any difference as, under the Dutch System, the hospital will have to cover the extra costs associated with the robot.
I’ll see if I can find out more about this study, but I it’ll be in Dutch so maybe not that easy to share it with you.

It’s odd, as I read another Dutch study that indicated that Da Vinci was better, for though it had the same outcome for ED it was better when it came to clear margins, BCR, continence and blood loss during surgery. This study was a review of the studies done by others including Cigna, ASERNIP-S, NICE,etc see: cvz.nl/binaries/live/cvzinternet/hst_content/nl/documenten/standpunten/2007/sp0705+prostatectomie+met+operatierobot.pdf

If the “problem” is that machines are not being used properly, then this sounds like the wrong way to find a solution. It’s like concluding a company’s trucks are too big and then only paying for the fuel for smaller trucks instead of getting rid of a the big trucks.

Alf

We want to avoid getting to politics please

I would think less time in the hospital aka less time to get exposed the a deadly virus etc would be worth considering. There are a lot of statistics about people getting sicker IN the hospital then they were before they entered.

David I was stretching things a bit, but we have 10 machines in the State of Alabama and they are used for all kinds of surgeries other than RALP's and kept busy all the time. Almost every major hospital now has a Davinci in Alabama and they are getting paid for with lots of surgeries.

Terry

For the record:
I chose da Vinci over open as my understanding was not that it would deal with the PCa any better, but that it had a better surgical outcome:
less time in hospital,
less blood loss during surgery,
quicker recovery
etc.

All three of the above save money: shorter time in hospital means less nursing care etc. lack of need for blood transfusion etc means less money on that and getting back to work sooner means it's better for the economy etc.
So looking at the overall picture it still seems to indciate to me that robot is better (=cheaper) even if effect on treatment of PCa is same.


I can kind of understand this if it's just about there being too many macines here. If there are 1200 RALPs a year in Holland and you can do surgery on about 250 days per year then you're doing about 5 a day spread over the whole country and allowing for maintenance you can cover than with about 3 machines not 16. So I'd like to work out what other operations are being done with the robot for the country to need 16 machines. I can find little mention of other uses for the robot in the report.

Alf

It is an interesting comparison - the group that privately financed the DaVinci at my hospital has a worksheet on actual use. From what I saw, prostatectomy is one of the lowest percentages of surgeries that the machine is used for. Female surgeries and gall bladders take the lead, and actually crowd out RPs, since the RP takes longer (the robot is billed by the hour with a minimum, and my surgery billed two extra hours because of difficulty - next person got delayed).

As to the arms, they are billed out as well - replaced with each use.

And for me - 4 days in the hosp., so no savings there

 

i thought the robot was a great thing. It would have been a lot harder for me had I been forced to go into traditional open surgery.

I'm surprised by this issue in Holland, however. My surgeon was just invited there to perform robotic surgeries. finance.yahoo.com/news/Dr-David-Samadi-Performs-iw-2276326321.html

I chose daVinci because of the theoretical advantages it indicated and the assurances of the specialist team who said it was the best method if you were insured or could afford to pay. The quote for open v robotic was if I recall about 2.5 times.

The findings I have read about robotic are far from clear but it is acknowledged that 100s of procedures are necessary to achieve top surgical skill with this method. On enquiring I discovered my surgeon had <200 under his belt. Other fit and healthy buck rabbits operated on by him around the time I had mine reported high levels of ED. I am no longer a cheerleader for daVinci but would plump for experience of the hands first.

I believe that locally, the daVinci is now being used for women's issues surgery (whatever that means!) The theory of accuracy achieved by scaling makes sense but ED rates seem to be remaining high. Most guys in their 40s and 50s facing prostatectomy seem to place nerve sparing ahead of everything except cancer cure so one wonders if robotic is the great advance once touted.