Assessing the adequacy of funding for robotic-surgery hospital stays: a focused cost analysis based on 1,722 procedures in a French university hospital.

Context: Robotic-assistance is increasingly used in French hospitals and funded through standard Diagnosis-Related Group (DRG) tariffs. We evaluated the actual costs of robotic-assisted surgical procedures (RASP) and compared these with hospital revenues to assess whether current funding levels are sufficient to cover procedural costs. Materials and methods: This cross-sectional study was conducted in Lyon University Hospitals (France). We examined all RASP performed over January 2023-June 2024. We matched medical device usage data from the DaVinci system manufacturer’s database with the hospital database, calculated related costs, and compared these against the costs/ tariffs of DRGs using the national cost benchmarks. Results: Based on a final sample of 1,722 procedures, we observed substantial cost variations between surgeries for RASP-specific medical devices, with higher-cost procedures such as those requiring staplers/ reloads (mean costs: €2,858 to €3,189) and lower-cost procedures (€1,207 to €1,621). Among the 21 most frequently performed surgeries, the mean length of stay (LoS) was numerically lower than national benchmarks in 20 cases. Fourteen were associated with mean costs of RASP devices exceeding the national benchmark within the same cost category (medical consumables) (range of additional cost: +€309 to +€2,428); incorporating potential savings resulting from reduced LoS could offset these additional costs in three cases. Medical consumable costs were lower for five surgeries (range of cost reduction: -€109 to -€726). Conclusions: In most cases, hospital funding based on current DRG tariffs is insufficient to cover the actual costs of RASP, suggesting that these stays are undervalued even though a reduced LoS may partially offset the additional costs.