Ontario's OHTAC rules against da Vinci surgery
The OHTAC in Ontario, Canada issued a new a new recommendation against public funding for robot-assisted prostatectomies has physician leaders warning this country could fall even further behind the rest of the developed world when it comes to offering cutting-edge medical procedures.
"In its first real ruling on a robotic surgery, the expert committee that advises Ontario on which new health technologies to pay for said there was no good evidence that robot-assisted radical prostatectomy is any better than conventional open surgery when it comes to controlling cancer or preserving urinary and sexual function.
The panel said the robot’s other benefits – patients have smaller incisions, lose less blood, suffer less pain and leave the hospital sooner – were not significant enough to justify spending, on average, an extra $3,224 a case, a figure that does not include the millions that wealthy benefactors have spent buying the machines for Canadian hospitals.
“We don’t have unlimited resources,” said Irfan Dhalla, vice-president of evidence development and standards at Health Quality Ontario, the agency that oversees the Ontario Health Technology Advisory Committee, known as OHTAC. “How do we spend the resources we do have to maximally benefit the people of Ontario?”
OHTAC’s recommendation, which is in the hands of Ontario’s health ministry, has sparked an outcry.
Four urologists and one general surgeon who advised OHTAC during its research asked that their names be removed from the final recommendation paper, published last month, because they disagreed so strongly with its conclusions. Urologists and chiefs of surgery at major teaching hospitals wrote letters, begging the committee to reconsider.
“This is a harbinger of bad things to come,” said James Rutka, chair of the surgical division at the University of Toronto’s medical school.
The fight over public funding for robot-assisted prostate surgery in Canada’s most populous province could have ripple effects in other provinces, and on other types of robotic surgery for which the benefits are more clear cut.
It could also sour top-flight surgical trainees on Canada, Dr. Rutka warned.
More profoundly, the fight raises a question: Should a public health-care system with little money to spare pay for a costly new technology when the old-fashioned approach might work just as well?"