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.
Age dx 48
04/09 PSA 8.6, DRE neg. Biop 2/12 pos. G=3+3
07/09 RALP at AVL Amsterdam
Cath out at 1wk Dry at night
PostOp G=3+4 Bladder neck & Left SVI -T3b. No PNI No vasc.inv. Clear margins
09/09 No pads
11/09 PSA 0.1
03/10 PSA 0.4 04/10 CT.
Summer/10 66Gy SRT
No real ED