Presentation Authors: Jeffrey Leow*, Singapore, Singapore, Ye Wang, Melissa Huynh, Alice Yu, Boston, MA, Keng Siang Png, Singapore, Singapore, Steven Chang, Boston, MA
Introduction: The treatment options for small renal masses (SRM, â‰¤4 cm) are associated with different costs despite all generally having excellent long-term prognoses. To better understand the cost implications of treating small renal masses, we calculated and determined the breakdown of lifetime costs for competing SRM treatments.
Methods: A Markov model with a 3-month cycle length was developed to estimate lifetime costs of treating SRMs from a payerâ€™s perspective. Management options included (1) immediate strategies with open partial nephrectomy (OPN), robotic partial nephrectomy (RPN), or percutaneous ablation (PA), and (2) delayed strategies with active surveillance followed potentially by OPN, RPN, or PA. The base case scenario was a cohort of healthy 65-year-old patients with asymptomatic unilateral SRMs. Key inputs were derived from the Premier Healthcare Database, a nationally representative hospital discharge database in the United States. Costs were inflated to 2016 USDs. Deterministic and probabilistic sensitivity analyses were performed to test alternative clinical scenarios and the model robustness, respectively.
Results: For the base case, immediate OPN was the least costly strategy ($111,981) while PA was the most expensive ($118,767), due to the higher cost of metastatic disease for PA. Active surveillance increased the OPN and RPN costs, due to increased probability of radical nephrectomy and associated chronic kidney disease (CKD), but reduced costs for PA. Compared to OPN, RPN was more costly ($1400 to $1800) across various clinical scenarios except for high volume surgeons (>15/year) and unhealthy patients (Charlson score â‰¥2) at which point RPN was associated with fewer complications. The primary financial burden associated with immediate treatment of SRM was post-treatment surveillance imaging costs (Figure).
Conclusions: The lifetime cost for all SRM treatment options is high ($110,000 to $120,000). This cost varies by probability of complications, incidence of metastasis, and risk of CKD. Regardless of treatment modality, the majority of the medical expenditure is the post-treatment imaging, which thus represents the ideal target to minimize the overall financial burden of kidney cancer.