Cost-effectiveness analysis: percutaneous microwave ablation vs robotic-assisted partial nephrectomy for small renal masses

Authors

Clinton Yeaman, Department of Urology, UVA Medical Center, University of Virginia, Fontaine Research Park, 500 Ray C. Hunt Drive, 1215 Lee Street, Charlottesville, VA, 22908, USA. cy5eb@virginia.edu.
Rebecca Marchant, School of Medicine, University of Virginia, Charlottesville, VA, USA.
Jennifer M. Lobo, Department of Urology, UVA Medical Center, University of Virginia, Fontaine Research Park, 500 Ray C. Hunt Drive, 1215 Lee Street, Charlottesville, VA, 22908, USA.
Anthony DeNovio, School of Medicine, University of Virginia, Charlottesville, VA, USA.
Lauren O'Connor, Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, VA, USA.
Tanya Wanchek, Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, VA, USA.
Christopher Ballantyne, Department of Urology, UVA Medical Center, University of Virginia, Fontaine Research Park, 500 Ray C. Hunt Drive, 1215 Lee Street, Charlottesville, VA, 22908, USA.
Drew L. Lambert, Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, USA.
Ayman Mithqal, Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, USA.
Noah Schenkman, Department of Urology, UVA Medical Center, University of Virginia, Fontaine Research Park, 500 Ray C. Hunt Drive, 1215 Lee Street, Charlottesville, VA, 22908, USA.

Document Type

Journal Article

Publication Date

10-9-2022

Journal

Abdominal radiology (New York)

DOI

10.1007/s00261-022-03692-1

Keywords

Ablation; Cost; Cost-effectiveness analysis; Partial nephrectomy; Small renal mass

Abstract

PURPOSE: The majority of newly diagnosed renal tumors are masses < 4 cm in size with treatment options, including active surveillance, partial nephrectomy, and ablative therapies. The cost-effectiveness literature on the management of small renal masses (SRMs) does not account for recent advances in technology and improvements in technical expertise. We aim to perform a cost-effectiveness analysis for percutaneous microwave ablation (MWA) and robotic-assisted partial nephrectomy (RA-PN) for the treatment of SRMs. METHODS: We created a decision analytic Markov model depicting management of the SRM incorporating costs, health utilities, and probabilities of complications and recurrence as model inputs using TreeAge. A willingness to pay (WTP) threshold of $100,000 and a lifetime horizon were used. Probabilistic and one-way sensitivity analyses were performed. RESULTS: Percutaneous MWA was the preferred treatment modality. MWA dominated RA-PN, meaning it resulted in more quality-adjusted life years (QALYs) at a lower cost. Cost-effectiveness analysis revealed a negative Incremental Cost-Effectiveness Ratio (ICER), indicating dominance of MWA. The model revealed MWA had a mean cost of $8,507 and 12.51 QALYs. RA-PN had a mean cost of $21,521 and 12.43 QALYs. Relative preference of MWA was robust to sensitivity analysis of all other variables. Patient starting age and cost of RA-PN had the most dramatic impact on ICER. CONCLUSION: MWA is more cost-effective for the treatment of SRM when compared with RA-PN and accounting for complication and recurrence risk.

APA Citation

Yeaman, Clinton; Marchant, Rebecca; Lobo, Jennifer M.; DeNovio, Anthony; O'Connor, Lauren; Wanchek, Tanya; Ballantyne, Christopher; Lambert, Drew L.; Mithqal, Ayman; and Schenkman, Noah, "Cost-effectiveness analysis: percutaneous microwave ablation vs robotic-assisted partial nephrectomy for small renal masses" (2022). GW Authored Works. Paper 1798.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/1798

Department

Public Health Student Works