The diffusion of robotic surgery: Examining technology use in the English NHS

Laia Maynou; Georgia Pearson; Alistair McGuire; Victoria Serra-Sastre

doi:10.1016/j.healthpol.2022.02.007

The diffusion of robotic surgery: Examining technology use in the English NHS

Health Policy. 2022 Apr;126(4):325-336. doi: 10.1016/j.healthpol.2022.02.007. Epub 2022 Feb 27.

Authors

Laia Maynou¹, Georgia Pearson², Alistair McGuire², Victoria Serra-Sastre³

Affiliations

¹ Department of Econometrics, Statistics and Applied Economics, Faculty of Economics and Business, Universitat de Barcelona, Avinguda Diagonal 690-696, 08034 Barcelona, Spain; Department of Health Policy, London School of Economics and Political Science, Houghton Street, WC2A 2AE London, UK; Center for Research in Health and Economics (CRES), Universitat Pompeu Fabra, Ramon Trias Fargas 25-27 08005 Barcelona, Spain. Electronic address: laia.maynou@ub.edu.
² Department of Health Policy, London School of Economics and Political Science, Houghton Street, WC2A 2AE London, UK.
³ Department of Economics, City, University of London, Northampton Square, EC1V 0HB London, UK; Department of Health Policy, London School of Economics and Political Science, Houghton Street, WC2A 2AE London, UK; Visiting Research Fellow, Office of Health Economics, 105 Victoria Street, London, SW1E 6QT, UK.

PMID: 35307200
DOI: 10.1016/j.healthpol.2022.02.007

Abstract

This paper examines the adoption and diffusion of medical technology as associated with the dramatic recent increase in the surgical use of robots. We consider specifically the sequential adoption and diffusion patterns of three interrelated surgical technologies within a single healthcare system (the English NHS): robotic, laparoscopic and open radical prostatectomy. Robotic and laparoscopic techniques are minimally invasive procedures with similar patient benefits, but the newer robotic technique requires a high initial investment cost to purchase the robot and carries high maintenance costs over time. Using data from a large UK administrative database, Hospital Episodes Statistics, for the period 2000-2018, we analyse 173 hospitals performing radical prostatectomy, the most prevalent and earliest surgical area of adoption of robotic surgery. Our empirical analysis first identifies substitution effects, with robotic surgery replacing the incumbent technology, including the recently diffused laparoscopic technology. We then quantify the spillover of robotic surgery as it diffuses to other surgical specialties. Finally, we perform time-to-event analysis at the hospital level to quantitatively examine the adoption. Results show that a higher number of urologists and a wealthier referral area favor robot adoption.

Keywords: Adoption; Diffusion; Robotic surgery; Substitution; Technology.

MeSH terms

Humans
Laparoscopy* / methods
Male
Prostatectomy / methods
Robotic Surgical Procedures* / methods
State Medicine
Technology