Cost-effectiveness analysis of microwave ablation versus robot-assisted partial nephrectomy for patients with small...

Microwave ablation (MWA) has gained attention as a minimally invasive and safe alternative to surgical intervention for patients with small renal masses; however, its cost-effectiveness in Australia remains unclear. This study conducted a cost-effectiveness analysis to evaluate the relative clinical and economic merits of MWA compared to robotic-assisted partial nephrectomy (RA-PN) in the treatment of small renal masses.

A Markov state-transition model was constructed to simulate the progression of Australian patients with small renal masses treated with MWA versus RA-PN over a 10-year horizon. Transition probabilities and utility data were sourced from comprehensive literature reviews, and cost data were estimated from the Australian health system perspective. Life-years, quality-adjusted life-years (QALYs), and lifetime costs were estimated. Modelled uncertainty was assessed using both deterministic and probabilistic sensitivity analyses. A willingness-to-pay (WTP) threshold of $50,000 per QALY was adopted. All costs are expressed in 2022 Australian dollars and discounted at 3% annually. To assess the broader applicability of our findings, a validated cost-adaptation method was employed to extend the analysis to 8 other high-income countries.

Both the base case and cost-adaptation analyses revealed that MWA dominated RA-PN, producing both lower costs and greater effectiveness over 10 years. The cost-effectiveness outcome was robust across all model parameters. Probabilistic sensitivity analyses confirmed that MWA was dominant in 98.3% of simulations at the designated WTP threshold, underscoring the reliability of the model under varying assumptions.

For patients with small renal masses in Australia and comparable healthcare settings, MWA is the preferred strategy to maximize health benefits per dollar, making it a highly cost-effective alternative to RA-PN.