Costing Analysis for the Management of Localized Renal Cell Carcinoma From the UK NHS Perspective
Author(s)
Hannah Tebbs, MSc1, Yuanyuan Zhang, MSc1, Lindsay Claxton, MMath1, Lucy Beggs, MSc2.
1NICE, London, United Kingdom, 2NICE, Manchester, United Kingdom.
1NICE, London, United Kingdom, 2NICE, Manchester, United Kingdom.
OBJECTIVES: Management of renal cell carcinoma (RCC) varies across the NHS. Due to high prevalence, variations in practice can translate to substantial difference in resource impact. This study compared treatment and downstream costs between surgical, non-surgical interventions, and active surveillance for localised RCC.
METHODS: A costing analysis using a clinician-validated treatment pathway estimated upfront, follow-up and downstream costs for each treatment option. Nephrectomy was estimated as an average cost using the proportions of laparoscopic, robot-assisted, and open surgery. Ablation cost was calculated as an average of radiofrequency ablation, cryoablation and microwave ablation. Multiple cost scenarios for stereotactic ablative radiotherapy (SABR) were explored. Costs for active surveillance and 5-year follow-up were based on clinical guidance and expert opinion. Recurrence management costs were included. Unit costs were from published literature reviews and national sources, adjusted to 2023/24 prices.
RESULTS: The average cost for nephrectomy was £10,153, with £10,198 for open nephrectomy, £10,026 for laparoscopic nephrectomy, £10,227 for robotic nephrectomy, £10,217 for partial nephrectomy and £10,124 for radical nephrectomy, respectively. The average cost for ablation was £3,223, with both radiofrequency and microwave ablation costing £2,314, and cryoablation costing £3,828. Treatment cost for SABR ranged from £2,107 to £2,907. Follow-up costs were £369 to £984 for nephrectomy, £738 for ablation and £1,284 for SABR. The first-year cost for active surveillance ranged from £421 to £501 with a subsequent annual cost from £123 to £128. Local and distant recurrence management costed £10,107 and £31,288, respectively.
CONCLUSIONS: Surgery has a higher initial treatment cost than other treatments. The management of recurrences, particularly metastatic RCC, are much more costly than the initial treatment. The absence of a robotic procedure in NHS reference costs may result in underestimation of its true cost as clinical experts suggest that it should be more expensive than open and laparoscopic procedures.
METHODS: A costing analysis using a clinician-validated treatment pathway estimated upfront, follow-up and downstream costs for each treatment option. Nephrectomy was estimated as an average cost using the proportions of laparoscopic, robot-assisted, and open surgery. Ablation cost was calculated as an average of radiofrequency ablation, cryoablation and microwave ablation. Multiple cost scenarios for stereotactic ablative radiotherapy (SABR) were explored. Costs for active surveillance and 5-year follow-up were based on clinical guidance and expert opinion. Recurrence management costs were included. Unit costs were from published literature reviews and national sources, adjusted to 2023/24 prices.
RESULTS: The average cost for nephrectomy was £10,153, with £10,198 for open nephrectomy, £10,026 for laparoscopic nephrectomy, £10,227 for robotic nephrectomy, £10,217 for partial nephrectomy and £10,124 for radical nephrectomy, respectively. The average cost for ablation was £3,223, with both radiofrequency and microwave ablation costing £2,314, and cryoablation costing £3,828. Treatment cost for SABR ranged from £2,107 to £2,907. Follow-up costs were £369 to £984 for nephrectomy, £738 for ablation and £1,284 for SABR. The first-year cost for active surveillance ranged from £421 to £501 with a subsequent annual cost from £123 to £128. Local and distant recurrence management costed £10,107 and £31,288, respectively.
CONCLUSIONS: Surgery has a higher initial treatment cost than other treatments. The management of recurrences, particularly metastatic RCC, are much more costly than the initial treatment. The absence of a robotic procedure in NHS reference costs may result in underestimation of its true cost as clinical experts suggest that it should be more expensive than open and laparoscopic procedures.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE281
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, Oncology