Cost-Effectiveness of Robot-Assisted and Laparoscopic Radical Nephrectomy Versus Open Radical Nephrectomy in the Treatment of Renal Cell Carcinoma
Author(s)
Mumbi E. Kimani, PhD1, Carolina Castagna, MD, MPH1, Inkyu Kim, PhD1, Daniel Huang, PharmD1, Costas D. Lallas, MD2, Vittorio Maio, MS, MSPH, PharmD1;
1Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, PA, USA, 2Department of Urology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
1Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, PA, USA, 2Department of Urology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
Presentation Documents
OBJECTIVES: The clinical oncologic outcomes of minimally invasive techniques, such as robot-assisted (RARN) and laparoscopic radical nephrectomy (LRN), are comparable to those of open radical nephrectomy (ORN), for renal cell carcinoma (RCC), with potentially fewer perioperative complications. However, concerns regarding high costs persist. This study aimed to evaluate the cost-effectiveness of RARN and LRN compared to ORN for treating RCC from a healthcare system perspective.
METHODS: A decision tree model was developed to estimate the cost-effectiveness of RARN and LRN relative to ORN, incorporating perioperative complications, including mortality, and inpatient costs. The model was parameterized using US-based published data. Probabilistic sensitivity analysis (PSA) was performed using 1,000 iterations of Monte Carlos simulations. A willingness-to-pay (WTP) threshold of S50,000 per quality-adjusted life year (QALY) gained was assumed for the analysis.
RESULTS: The mean inpatient costs were $16,712 for ORN, $15,644 for RARN, and $13,683 for LRN. Perioperative complications were 8% for RARN, 7% for LRN, and 16% for ORN. The ORN resulted in 0.45 QALYs, compared to 0.52 QALYs from RARN and 0.53 QALYs from LRN. The incremental cost-effectiveness ratio (ICER) was estimated for RARN at -$17,024 and LRN at -$39,580, indicating that both RARN and LRN dominated ORN. PSA results demonstrated that RARN and LRN had robust cost-effectiveness relative to ORN, with probabilities ranging from 43.7% to 78.9% and 54.1% to 86%, respectively. The limitations included combining charges and marginal costs from diverse sources, using utility values from similar surgical complications rather than RN-specific complications, and focusing solely on in-hospital estimates without accounting for societal costs.
CONCLUSIONS: The results suggest that both RARN and LRN are cost-effective compared to ORN in treating RCC, with LRN being notably much more cost-effective than RARN. Further research is warranted to corroborate these findings and to explore whether LRN is more cost-effective than RARN.
METHODS: A decision tree model was developed to estimate the cost-effectiveness of RARN and LRN relative to ORN, incorporating perioperative complications, including mortality, and inpatient costs. The model was parameterized using US-based published data. Probabilistic sensitivity analysis (PSA) was performed using 1,000 iterations of Monte Carlos simulations. A willingness-to-pay (WTP) threshold of S50,000 per quality-adjusted life year (QALY) gained was assumed for the analysis.
RESULTS: The mean inpatient costs were $16,712 for ORN, $15,644 for RARN, and $13,683 for LRN. Perioperative complications were 8% for RARN, 7% for LRN, and 16% for ORN. The ORN resulted in 0.45 QALYs, compared to 0.52 QALYs from RARN and 0.53 QALYs from LRN. The incremental cost-effectiveness ratio (ICER) was estimated for RARN at -$17,024 and LRN at -$39,580, indicating that both RARN and LRN dominated ORN. PSA results demonstrated that RARN and LRN had robust cost-effectiveness relative to ORN, with probabilities ranging from 43.7% to 78.9% and 54.1% to 86%, respectively. The limitations included combining charges and marginal costs from diverse sources, using utility values from similar surgical complications rather than RN-specific complications, and focusing solely on in-hospital estimates without accounting for societal costs.
CONCLUSIONS: The results suggest that both RARN and LRN are cost-effective compared to ORN in treating RCC, with LRN being notably much more cost-effective than RARN. Further research is warranted to corroborate these findings and to explore whether LRN is more cost-effective than RARN.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EE497
Topic
Economic Evaluation
Disease
SDC: Oncology, SDC: Urinary/Kidney Disorders, STA: Surgery