Robot-assisted surgery is an exciting proposition for both patients and specialists – that futuristic assembly of high-tech arms and surgical tools, driven by the surgeon and promising precise, clean, tremor-free and minimally-invasive procedures.
It’s a promise that’s seen hospitals throughout the UK investing ever more rapidly in the technology. Those facilities understandably want to maximise use and that’s a challenge for insurers such as AXA Health. We want to fund safe, effective care for our members, which means we need evidence that these procedures actually bring clinical benefits – for example, shorter surgery times or better surgical outcomes.
The rising number of procedures being carried out and the creation of centres of excellence mean that robotics surgery in some conditions is becoming the standard of care – sometimes in the absence of NICE approval. So, we also need to ensure our decisions on funding keep pace with current medical practice.
Our duty of care to members allies with our need to seek value for our customers: robot-assisted surgery adds several thousand pounds to the cost of a procedure.
Seeking the evidence
We follow a strict set of guidelines when checking the evidence for authorising procedures. Understanding we needed to know more about robot-assisted procedures, AXA Health commissioned an independent series of evidence reviews in four separate and growing areas of robotics: head and neck, chest (including lungs), colorectal and bladder surgery.
We also drew up a set of criteria we ask surgeons to meet before carrying out robot-assisted surgery, covering appropriate training, experience, record keeping and data sharing on outcomes.
Working across the private sector
The result is a defined set of procedures that we’ll fund or consider authorising, confident that they bring clinical benefit to our members. However, we always encourage specialists to contact us to share research and discuss our findings, which are published on our Provider website. This work has enhanced our relationships with professional surgical organisations, which appreciate the clinical rigour of our findings, and has been welcomed by the robotics manufacturers.
We’re proud of this collegiate approach to stakeholders in the debate, because we feel we should be working across the entire private healthcare sector to reach good funding decisions which benefit all our members.
Dr John Burke
Director of Medical Policy, AXA Health
Dr John Burke combines his role as Director of Medical Policy for AXA Health with his continuing GP practice. He was educated at Cambridge and Oxford Universities, where he pursued an interest in neuroscience. In his role he steers AXA Health's policy in areas such as evidence-based medicine, value-based commissioning, overdiagnosis and low-value care, service design, supply chain management and regulatory oversight.
Source articles:
1 Robotic Surgery, Consumables and Related Services - NHS SBS
2 Uptake and accessibility of surgical robots in England, Lam et al, Wiley, 2020 (Uptake and accessibility of surgical robotics in England - Lam - 2021 - The International Journal of Medical Robotics and Computer Assisted Surgery - Wiley Online Library)
3 Medical policy (axahealth.co.uk)
4 ramis-colorectal-august-22-final.pdf (axahealth.co.uk)
5 ramis-cystectomy-august-22-final.pdf (axahealth.co.uk)
6 Estimation of the Acquisition and Operating Costs for Robotic Surgery | Minimally Invasive Surgery | JAMA | JAMA Network
7 Patient safety tool (axahealth.co.uk)
8 Robotics (axahealth.co.uk)