OBJECTIVES

: Partial nephrectomy is considered as the preferred surgical treatment to radical nephrectomy for patients with cT1 renal cancer in multiple guidelines (EAU guideline 2015, AUA 2009). The objective of this study is to examine the cost effectiveness of robotic-assisted partial nephrectomy (RAPN) against open radical nephrectomy for treating cT1 renal cancer.

METHODS

: A Markov model consisting of 6 health states (Initial Post Surgery, Normal Renal Function, Chronic Kidney Disease (CKD), Dialysis, Death from Renal Failure, Natural Death) was used to assess costs and utilities in patients with cT1 renal cancer. Utilities and transition probabilities were obtained from a systematic literature review. Cost data, including the intervention cost and maintenance cost, were obtained from the current fee schedule and Korean medical literature. Univariate and probabilistic sensitivity analyses (PSA) were performed.

RESULTS

: RAPN suggests to be the dominant treatment with 4.1 million KRW less cost and 0.61 higher utility than ORN. Univariate sensitivity analysis showed that the most sensitive parameters were the relative risk of CKD after partial nephrectomy and the health utility of the CKD state. The PSA result showed that the acceptability of RAPN at the 30.5 million KRW threshold was 76.4% (vs. ORN was 23.6%).

CONCLUSIONS

: Though there might be uncertainties from various and non-Korean utility data, the current study suggests that PN can be a more cost-effective option than ORN in Korea for patients with cT1 renal cancer.