Cost analysis of open, laparoscopic, and percutaneous treatment options for nephron-sparing surgery

Background and Purposes: A variety of nephron-sparing options exist for the management of small renal masses. The perioperative cost of open (OPN) and laparoscopic (LPN) partial nephrectomy, laparoscopic (LCA), and CT-guided percutaneous (PCA) cryoablation was compared using a detailed computer model. Patients and Methods: The model incorporates operative time, consurnables, anesthesia, CT usage, percutaneous biopsy, hospitalization, and transfusion expenses. Starting values were derived from a retrospective review of 317 patients treated at the Johns Hopkins Medical Institutions within the past 7 years. Hypothesis testing was performed with sensitivity analysis. Results: The PCA was 2.2 to 2.7 times less costly than the other options and resulted in a cost savings of $3625 to $5155 per case. For OPN, LPN, and LCA, the operative time and hospitalization accounted for 69% to 91% of the cost. In contrast, cryoprobe consumables were responsible for > 70% of total cost of PCA. An OPN was 1.2X as costly as LPN and could achieve cost equivalence only with operative times of < 2.8 hours or hospitalization of < 3 days. An LCA was more costly than all forms of extirpative surgery if more than two cryoprobes were used. Reusing cryoprobes during LCA was always a less-costly option than adding a second cryoprobe to the procedure. The LCA was no longer cost advantageous over OPN if more than four CT scans were obtained during the first postoperative year or if local recurrence rates exceeded 23%. Conclusions: This model defines and simplifies a series of complex cost relations between the options for nephron-sparing surgery.