Cost-utility analysis of radical nephrectomy versus partial nephrectomy in the management of small renal masses: adjusting for the burden of ensuing chronic kidney disease
- 16 April 2013
- journal article
- research article
- Published by Canadian Urological Association Journal in Canadian Urological Association Journal
- Vol. 7 (3-4), 108-13
- https://doi.org/10.5489/cuaj.502
Abstract
Objectives: To compare the cost-utility of laparoscopic radical nephrectomy (LRN), laparoscopic partial nephrectomy (LPN) and open partial nephrectomy (OPN) in the management of small renal masses (SRMs) when the impact of ensuing chronic kidney disease (CKD) disease is considered. Methods: We designed a Markov decision analysis model with a 10-year time horizon. Estimates of costs, utilities, complication rates and probabilities of developing CKD were derived from the literature. The base case patient was assumed to be a 65-year-old patient with a <4 cm unilateral renal mass, a normal contralateral kidney and a normal pre-operative serum creatinine. Univariate and probabilistic sensitivity analyses were conducted to address the uncertainty associated with the study parameters. Results: OPN was the least costly strategy at $25941 USD and generated 7.161 QALYs over 10 years. LPN yielded 0.098 additional QALYs at an additional cost of $888 for an incremental cost-effectiveness ratio of $9057 per QALY, well below a commonly cited willingness-to-pay threshold of $50000 per QALY. LRN was more costly and yielded fewer QALYs than OPN and LPN. Sensitivity analyses demonstrated our model to be robust to changes to key parameters. Age had no effect on preferred strategy. Conclusions: Partial nephrectomy (PN) is the preferred treatment strategy for SRMs. In centers where LPN is not available, OPN remains considerably more cost-effective than LRN. Furthermore, our study demonstrates that there is no age at which PN is not preferred to LRN. Our study provides additional evidence to advocate PN for the management of all amenable SRMs.Keywords
This publication has 28 references indexed in Scilit:
- Trends in renal tumor surgery delivery within the United StatesCancer, 2010
- Quality of life and perioperative outcomes after retroperitoneoscopic radical nephrectomy (RN), open RN and nephron-sparing surgery in patients with renal cell carcinomaBJU International, 2009
- A Comparative Study of Quality of Life Issues Relating to Open Versus Laparoscopic Nephrectomy: A Prospective Pragmatic StudyJournal of Urology, 2009
- Partial Nephrectomy Versus Radical Nephrectomy in Patients With Small Renal Tumors—Is There a Difference in Mortality and Cardiovascular Outcomes?Journal of Urology, 2009
- Does Obesity Impact the Costs of Partial and Radical Nephrectomy?Journal of Urology, 2008
- Comparison of 1,800 Laparoscopic and Open Partial Nephrectomies for Single Renal TumorsJournal of Urology, 2007
- Chronic kidney disease after nephrectomy in patients with renal cortical tumours: a retrospective cohort studyThe Lancet Oncology, 2006
- Health-Related Quality of Life after Retroperitoneoscopic and Hand-Assisted Laparoscopic NephrectomyJournal of Endourology, 2005
- Chronic Kidney Disease and the Risks of Death, Cardiovascular Events, and HospitalizationNew England Journal of Medicine, 2004
- Longitudinal Follow-up and Outcomes Among a Population With Chronic Kidney Disease in a Large Managed Care OrganizationArchives of Internal Medicine, 2004