Cost comparison of nephron-sparing treatments for cT1a renal masses

• Published in: Urologic oncology 2013-10, Vol.31 (7), p.1327-1332
• Main Authors: Castle, Scott M., M.D, Gorbatiy, Vladislav, M.D, Avallone, Michael A., B.S, Eldefrawy, Ahmed, M.D, Caulton, Darryl E., M.B.A, Leveillee, Raymond J., M.D., F.R.C.S.-G
• Format: Article
• Language: English
• Subjects: Aged; Catheter Ablation - economics; Catheter Ablation - methods; Cost; Cost-Benefit Analysis; Female; Humans; Kidney - pathology; Kidney - surgery; Kidney Neoplasms - pathology; Kidney Neoplasms - surgery; Laparoscopy; Length of Stay - economics; Linear Models; Male; Middle Aged; Multivariate Analysis; Nephrectomy - economics; Nephrectomy - methods; Nephrons; Outcome Assessment (Health Care) - economics; Partial nephrectomy; Renal ablation; Renal mass; Tomography, X-Ray Computed; Urology
• ISSN: 1078-1439; 1873-2496
• DOI: 10.1016/j.urolonc.2012.01.006

Abstract Objectives Treatment options for small renal tumors have evolved from radical nephrectomy (RN) to partial nephrectomy (PN), thermal ablation, or active surveillance. With the advancement of techniques, costs differences are unclear. The objective of this study is to compare the 6-month costs associated with nephron-sparing procedures for cT1a renal tumors. Materials and methods We performed a review of patients diagnosed with a solitary cT1a renal mass who underwent surgical treatment from June 2008 to May 2011. Open partial nephrectomy (OPN), robot-assisted partial nephrectomy (RLPN), laparoscopic radio-frequency ablation (LRFA), or computed tomography guided radio frequency ablation (CTRFA) was performed on 173 patients. Cost data were collected for surgical costs, associated hospital stay, and the 6-month postoperative period. Results Patients underwent surgery, including 52 OPN, 48 RLPN, 44 LRFA, and 29 CTRFA. Median total costs associated were $17,018, $20,314, $13,965, and $6,475, for OPN, RLPN, LRFA, and CTRFA, respectively. When stratified by approach differences were noted for total cost ( P < 0.001), operating room (OR) time ( P < 0.001), surgical supply ( P < 0.001), and room and board ( P < 0.001) in univariable analysis. Multivariable linear regression ( R2 = 0.966) showed surgical approach ( P = 0.007), length of stay ( P < 0.001), and OR time ( P < 0.001) to be significant predictors of total cost. However, tumor size ( P = 0.175), and Charlson comorbidity index ( P = 0.078) were not statistically significant. Conclusions Six-month cost of nephron-sparing surgery is lowest with radio frequency ablation (RFA) by either laparoscopic or computed tomography (CT)-guided approach compared to RLPN and OPN. As oncologic and safety outcomes improve and become comparable in all nephron-sparing surgery (NSS) approaches, cost of each procedure will start to play a stronger role in the clinical and healthcare policy setting.