PERIOPERATIVE COST-EFFECTIVENESS OF PARTIAL NEPHRECTOMY TECHNIQUES FOR RENAL CELL CARCINOMA IN THE UNITED STATES
Author(s)
Vietbao Huynh Phan, PharmD1, Mumbi E. Kimani, MA, PhD2, elizabeth sottung, PharmD1, Vittorio Maio, MS, MSPH, PharmD2, Inkyu Kim, PhD3, Costas Lallas, MD, FACS2.
1Thomas Jefferson University, College of Population Health, Philadelphia, PA, USA, 2Thomas Jefferson University, Philadelphia, PA, USA, 3Merck, Rahway, NJ, USA.
1Thomas Jefferson University, College of Population Health, Philadelphia, PA, USA, 2Thomas Jefferson University, Philadelphia, PA, USA, 3Merck, Rahway, NJ, USA.
OBJECTIVES: Robotic-assisted partial nephrectomy (RAPN) has emerged as the preferred minimally invasive technique for localized renal tumors, largely replacing conventional laparoscopic partial nephrectomy (LPN). However, the higher hospital costs associated with RAPN raise questions about its comparative value versus LPN and open partial nephrectomy (OPN). This study assessed the cost-effectiveness of RAPN, LAPN, and OPN from a U.S. hospital perspective, focusing on inpatient perioperative outcomes.
METHODS: A decision tree model was developed using published U.S. parameters to estimate cost-effectiveness. Model inputs included inpatient perioperative complications rates, in-hospital mortality, inpatient costs, and short-term perioperative health state utilities. Quality-adjusted life-years (QALYs) captured perioperative quality-adjusted survival. A probabilistic sensitivity analysis (PSA) was conducted using 1,000 Monte Carlos simulations.
RESULTS: Mean inpatient costs were $12,481 (OPN), $13,601 (RAPN), and $12,815 (LPN). Complication rates were lower for RAPN (6%) and LPN (7.6%) than OPN (12.1%). Perioperative QALYs were 0.55 (OPN), 0.78 (RAPN), and 0.76 (LPN). Both minimally invasive approaches were highly cost-effective versus OPN, with incremental cost-effectiveness ratios (ICERs) of $4,957/QALY for RAPN and $1,626/QALY for LPN. The ICER for RAPN versus LPN was $38,109/QALY, indicating a modest QALY advantage for RAPN at a substantially higher cost. PSA demonstrated >95% probability of cost-effectiveness for both RAPN and LPN versus OPN across standard willingness-to-pay thresholds, with LPN remaining more cost-effective except at very high thresholds. Limitations include the lack of tumor complexity data, reliance on proxy perioperative utility values, and assumption of equal complication costs for RAPN and LPN.
CONCLUSIONS: RAPN and LPN are cost-effective alternatives to OPN when evaluated over the inpatient perioperative episode, with LPN demonstrating greater cost efficiency. RAPN yields slightly higher perioperative QALYs compared to LPN; however, the incremental gain is modest relative to its additional cost. Further research should incorporate tumor complexity, long-term outcomes, and societal outcomes to fully assess the value of these procedures.
METHODS: A decision tree model was developed using published U.S. parameters to estimate cost-effectiveness. Model inputs included inpatient perioperative complications rates, in-hospital mortality, inpatient costs, and short-term perioperative health state utilities. Quality-adjusted life-years (QALYs) captured perioperative quality-adjusted survival. A probabilistic sensitivity analysis (PSA) was conducted using 1,000 Monte Carlos simulations.
RESULTS: Mean inpatient costs were $12,481 (OPN), $13,601 (RAPN), and $12,815 (LPN). Complication rates were lower for RAPN (6%) and LPN (7.6%) than OPN (12.1%). Perioperative QALYs were 0.55 (OPN), 0.78 (RAPN), and 0.76 (LPN). Both minimally invasive approaches were highly cost-effective versus OPN, with incremental cost-effectiveness ratios (ICERs) of $4,957/QALY for RAPN and $1,626/QALY for LPN. The ICER for RAPN versus LPN was $38,109/QALY, indicating a modest QALY advantage for RAPN at a substantially higher cost. PSA demonstrated >95% probability of cost-effectiveness for both RAPN and LPN versus OPN across standard willingness-to-pay thresholds, with LPN remaining more cost-effective except at very high thresholds. Limitations include the lack of tumor complexity data, reliance on proxy perioperative utility values, and assumption of equal complication costs for RAPN and LPN.
CONCLUSIONS: RAPN and LPN are cost-effective alternatives to OPN when evaluated over the inpatient perioperative episode, with LPN demonstrating greater cost efficiency. RAPN yields slightly higher perioperative QALYs compared to LPN; however, the incremental gain is modest relative to its additional cost. Further research should incorporate tumor complexity, long-term outcomes, and societal outcomes to fully assess the value of these procedures.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE271
Topic
Economic Evaluation
Disease
SDC: Oncology, SDC: Urinary/Kidney Disorders