There will be further changes to the most popular robotic procedure

• The Ministry of Health is analyzing changes in the rules for performing radical prostatectomy using robots.
• It's possible that the revised regulations will lower the cost of procedures and facilitate the training of young doctors. This is important following the July decision to reduce the cost of robotic surgery by 14%.
• Surgical robots offer better clinical outcomes for patients, but their cost-effectiveness for the system is still debated.

The issue of requirements and conditions for performing radical prostatectomy using a surgical robot is currently the subject of internal analysis, the Ministry of Health informed us.

Decisions regarding any changes in this area will be made after completing analyses and further consultations with the medical community. We also inquired with the National Health Fund about this issue, but they referred us to the ministry.

So we don't know what direction the changes will take. For some time now, there's been talk behind the scenes in government offices that, for example, the requirement for two experienced robot operators to be present on a block might be abolished. It's possible that instead, the second person could be a trainee operator.

The solution would not only facilitate education, but also "free" one operator from the need to supervise a relatively repetitive procedure and reduce the costs of the operation.

The latter is particularly important in the context of the July decision to reduce the price of robotic radical prostatectomy by 14% (from PLN 32,700 to PLN 28,100 ). The rate is now similar to that paid for laparoscopic surgery ( approximately PLN 23,000 ).

Magdalena Dzierwa , director of the AOTMiT tariff department, explained during a press conference at the National Health Fund (NFZ) headquarters that the valuation had been "realised", taking into account the actual costs of providing the service, the fact that robots are becoming more popular (which increases the possibilities of negotiating the terms of use of the equipment with distributors) and the use of devices in all three areas with a separate NFZ valuation:

• prostatectomy ,
• colon cancer surgery
• endometrial surgery.

According to Dzierwa, this reduces hospital overhead costs. Robots can also be used to perform a wider range of surgeries, although only at rates comparable to those for traditional or laparoscopic procedures.

- Surgeons are also performing procedures better and better, so the duration of operations is shorter and the operating theater is optimally used - argued Magdalena Dzierwa.

At the same time, a representative of AOTMiT informed that the Agency was working on issuing recommendations for the Ministry of Health regarding lung and kidney cancer surgery.

The rates for endometrial and colon cancer treatments are also to be reassessed, but the Agency needs to collect more data for this purpose (as these procedures are still not very popular).

Costs versus benefits for patients and the system

At the end of June this year, the editorial office of Rynek Zdrowia analyzed data on the costs and benefits of using modern surgical devices for radical prostatectomy procedures.

It turned out that the use of robots slightly shortens the duration of hospitalization, although from an economic perspective, it does not necessarily justify the until recently prevailing cost of robotic surgery.

However, benefits are also evident in other areas: lower mortality and fewer complications. The statistics did not mention reduced blood loss, greater patient comfort, or greater convenience for surgeons.

While patients can count on better clinical results in the case of robotic procedures (which is also confirmed by numerous scientific publications, but only in the case of radical prostatectomy), from the point of view of the health care system it is difficult to talk about spectacular, positive effects, especially if we take into account the costs before the correction recommended by AOTMiT.

Shortly after our publication , the National Health Fund provided similar statistics, adding that the number of robotic radical prostatectomy procedures is disproportionate to the epidemiological data on the incidence of prostate cancer.

We have learned unofficially that the reduced valuation of these procedures developed by AOTMiT is intended not only to make the rates paid by the Fund more realistic, but also to "rationalize the use of robots on the market."

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