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Perioperative Cost Comparison between Percutaneous Microwave Ablation and Partial Nephrectomy for Localized Renal
Clinton Yeaman1, Lauren O'Connor2, Jennifer Lobo2
1Department of Urology, University of Virginia, Charlottesville, Virginia.
Introduction:
We sought to determine and compare the perioperative cost associated with percutaneous microwave ablation (MWA) and robot-assisted partial nephrectomy (RA-PN) for treatment of localized renal masses (LRMs).
Methods:
We conducted a retrospective cohort analysis of a prospectively maintained IRB-approved LRM database. The database was queried for patients treated with microwave ablation or partial nephrectomy from 2015 to 2020. Allocated costs related to the procedural encounter and related to complications were collected. Allocated cost was calculated using ratio of cost-to-charges cost accounting methodology. Total cost was the sum of medical center cost and physician related cost. Statistical analysis was performed in SAS using Student's t-test and the Wilcoxon rank-sum test.
Results:
A total of 279 patients were identified, of whom 165 underwent percutaneous MWA and 114 underwent RA-PN. All partial nephrectomies were robot-assisted. The mean total cost was $20,536 for RA-PN and $6,470 for percutaneous MWA (p <0.0001). Five patients (3%) who underwent MWA and 7 (6%) who underwent RA-PN experienced complications. Patients who underwent MWA and did not have a major complication had an average medical center cost of $5,174, compared to $8,990 for those with a major complication (p=0.36). Among patients who underwent RA-PN, those who did not have a major complication had an average medical center cost of $15,138, compared to $28,940 for those who did have a major complication (p=0.008).
Conclusions:
MWA demonstrates lower perioperative cost and lower cost of complications than RA-PN for treatment of LRM. Further cost-effectiveness studies for LRM treatment should be performed with this updated cost information.
Insights
Percutaneous microwave ablation (MWA) is significantly less expensive than robot-assisted partial nephrectomy (RA-PN) for localized renal masses. MWA also shows lower complication costs, making it a more cost-effective treatment option.
Area of Science:
- Urology
- Minimally Invasive Surgery
- Health Economics
Background:
- Localized renal masses (LRMs) require effective treatment strategies.
- Perioperative costs of different LRM treatments vary significantly.
- Comparing percutaneous microwave ablation (MWA) and robot-assisted partial nephrectomy (RA-PN) is crucial for cost-effective patient care.
Purpose of the Study:
- To determine and compare the perioperative costs of MWA versus RA-PN for treating LRMs.
- To analyze the cost implications of complications associated with each procedure.
Main Methods:
- Retrospective cohort analysis of a prospectively maintained LRM database (2015-2020).
- Inclusion of patients treated with MWA or RA-PN.
- Calculation of allocated costs using cost-to-charges methodology, including medical center and physician costs.
Main Results:
- A total of 279 patients (165 MWA, 114 RA-PN) were analyzed.
- Mean total perioperative cost was significantly lower for MWA ($6,470) compared to RA-PN ($20,536) (p <0.0001).
- Complication rates were similar (3% MWA, 6% RA-PN), but RA-PN had significantly higher costs associated with major complications (p=0.008).
Conclusions:
- Percutaneous microwave ablation (MWA) demonstrates substantially lower perioperative costs than robot-assisted partial nephrectomy (RA-PN) for LRM treatment.
- MWA also incurs lower costs related to complications.
- Updated cost data supports MWA as a more cost-effective option, warranting further cost-effectiveness studies.
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