Cost-utility analysis of radical nephrectomy versus partial nephrectomy in the management of small renal masses: adjusting for the burden of ensuing chronic kidney disease

Authors

  • Zachary Klinghoffer Division of Urology, McMaster University, Hamilton, Ontario, Canada
  • Jean-Eric Tarride Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario Canada
  • Giacomo Novara Department of Oncological and Surgical Sciences, Urology Clinic, University of Padua, Padua Italy
  • Vincenzo Ficarra Department of Oncological and Surgical Sciences, Urology Clinic, University of Padua, Padua Italy
  • Anil Kapoor Division of Urology, McMaster University, Hamilton, Ontario, Canada
  • Bobby Shayegan Division of Urology, McMaster University, Hamilton, Ontario, Canada
  • Luis H. Braga Division of Urology, McMaster University, Hamilton, Ontario, Canada

DOI:

https://doi.org/10.5489/cuaj.502

Abstract

Objectives: To compare the cost-utility of laparoscopic radical nephrectomy (LRN), laparoscopic partial nephrectomy (LPN) and open partial nephrectomy (OPN) in the management of small renal masses (SRMs) when the impact of ensuing chronic kidney disease (CKD) disease is considered.

Methods: We designed a Markov decision analysis model with a 10-year time horizon. Estimates of costs, utilities, complication rates and probabilities of developing CKD were derived from the literature. The base case patient was assumed to be a 65-year-old patient with a <4 cm unilateral renal mass, a normal contralateral kidney and a normal pre-operative serum creatinine. Univariate and probabilistic sensitivity analyses were conducted to address the uncertainty associated with the study parameters.

Results: OPN was the least costly strategy at $25941 USD and generated 7.161 QALYs over 10 years. LPN yielded 0.098 additional QALYs at an additional cost of $888 for an incremental cost-effectiveness ratio of $9057 per QALY, well below a commonly cited willingness-to-pay threshold of $50000 per QALY. LRN was more costly and yielded fewer QALYs than OPN and LPN. Sensitivity analyses demonstrated our model to be robust to changes to key parameters. Age had no effect on preferred strategy.

Conclusions: Partial nephrectomy (PN) is the preferred treatment strategy for SRMs. In centers where LPN is not available, OPN remains considerably more cost-effective than LRN. Furthermore, our study demonstrates that there is no age at which PN is not preferred to LRN. Our study provides additional evidence to advocate PN for the management of all amenable SRMs.

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Published

2013-04-16

How to Cite

Klinghoffer, Z., Tarride, J.-E., Novara, G., Ficarra, V., Kapoor, A., Shayegan, B., & Braga, L. H. (2013). Cost-utility analysis of radical nephrectomy versus partial nephrectomy in the management of small renal masses: adjusting for the burden of ensuing chronic kidney disease. Canadian Urological Association Journal, 7(3-4), 108–13. https://doi.org/10.5489/cuaj.502

Issue

Vol. 7 No. 3-4 (2013): CUAJ April

Section

Original Research

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