Cost analysis of two follow-up strategies for localized kidney cancer: a Canadian cohort comparison

Authors

  • Marie Dion Division of Urology, Department of Surgery and Division of Surgical Oncology, Department of Oncology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON, Canada
  • Carlos H. Martínez Division of Urology, Department of Surgery and Division of Surgical Oncology, Department of Oncology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON, Canada; Division of Surgical Oncology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON
  • Andrew K. Williams Division of Urology, Department of Surgery and Division of Surgical Oncology, Department of Oncology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON, Canada; Division of Surgical Oncology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON
  • Venu Chalasani Division of Urology, Department of Surgery and Division of Surgical Oncology, Department of Oncology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON, Canada; Division of Surgical Oncology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON
  • Linda Nott Division of Urology, Department of Surgery and Division of Surgical Oncology, Department of Oncology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON, Canada
  • Stephen E. Pautler Division of Urology, Department of Surgery and Division of Surgical Oncology, Department of Oncology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON, Canada; Division of Surgical Oncology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON

DOI:

https://doi.org/10.5489/cuaj.904

Abstract

Introduction: The cost of surveillance strategies in patients after
radical nephrectomy for localized primary renal cell carcinoma
(RCC) has not been evaluated. We compared the costs of 2 different
surveillance strategies, the new Canadian Urological Association
(CUA) guidelines and the old strategy implemented in our institution.

Methods: Seventy-five patients who underwent radical nephrectomy
for primary non-metastatic renal cancer were retrospectively
reviewed. The direct cost of surveillance was determined and compared
with the theoretical cost which would have been accrued
using the CUA guidelines.

Results: Our mean follow-up was 31.1 (SD ± 20.4) months. The
overall and disease-free survival endpoints were 87.7% and 85.2%,
respectively. Total medical costs were higher for our old institutional
surveillance strategy than the CUA guidelines ($181 861
vs. $135 054). For the complete follow-up of 75 patients, a costsavings
of $46 806 could have been achieved following the CUA
guidelines (p = 0.002). Of recurrences, 7 of 8 were detected by routine
screening, only 1 recurrence was identified by symptoms. The
cost per recurrence detected in our old protocol was $9 812.92.
The increased cost of our institution was due to more visits with
basic testing, symptomatic investigation, and follow-up of imaging
tests. The median percent cost attributable to these extra tests was
15% (range 0 to 59).

Conclusion: Based on our results, we endorse the new CUA surveillance
strategy in RCC follow-up as appropriate and cost effective in
comparison with previous follow-up strategies used at our institution.
Can Urol Assoc J 2010;4(5):322-326

Introduction : Le coût associé aux stratégies de surveillance des
patients ayant subi une néphrectomie radicale en raison d’un hypernéphrome
primitif localisé n’a jamais été évalué. Nous avons comparé
les coûts de deux stratégies de surveillance différentes, soit
les nouvelles lignes directrices de l’Association des urologues du
Canada (AUC) et l’ancienne stratégie utilisée à notre établissement.

Méthodologie : Soixante-quinze patients qui ont subi une néphrectomie
radicale en raison d’un néphrome primitif non métastatique
ont été passés en revue de façon rétrospective. Les coûts directs de
la surveillance ont été déterminés et comparés avec le coût théorique
qui aurait été comptabilisé en suivant les lignes directrices de l’AUC.

Résultats : La durée moyenne du suivi était de 31,1 mois (ÉT ± 20,4).
La survie globale et la survie sans maladie étaient de 87,7 % et 85,2
%, respectivement. Les coûts médicaux totaux étaient plus élevés avec
l’ancienne stratégie de surveillance de notre établissement par rapport
aux lignes directrices de l’AUC (181 861 $ contre 135 054 $). Des
économies de 46 806 $ auraient pu être réalisées en suivant les
lignes directrices de l’AUC pour le suivi complet des 75 patients
(p = 0,002). Quant aux récurrences, 7 sur 8 ont été décelées lors
de tests de routine, et une seule a été décelée par la présence de
symptômes. Le coût d’une récurrence décelée selon notre ancien
protocole était de 9 812,92 $. Le coût plus élevé lié au protocole de
notre établissement est attribuable à un nombre plus élevé de visites
avec épreuves de routine, vérification des symptômes et suivi des
épreuves d’imagerie. Le pourcentage médian du coût attribuable à
ces épreuves supplémentaires était de 15 % (0 à 59 %).

Conclusion : En fonction de nos résultats, nous appuyons la nouvelle
stratégie de surveillance de l’AUC pour le suivi des cas
d’hypernéphrome; cette stratégie nous semble approprié et rentable
en comparaison avec les stratégies auparavant utilisées à notre

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Author Biographies

Marie Dion, Division of Urology, Department of Surgery and Division of Surgical Oncology, Department of Oncology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON, Canada

Carlos H. Martínez, Division of Urology, Department of Surgery and Division of Surgical Oncology, Department of Oncology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON, Canada; Division of Surgical Oncology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON

Andrew K. Williams, Division of Urology, Department of Surgery and Division of Surgical Oncology, Department of Oncology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON, Canada; Division of Surgical Oncology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON

Venu Chalasani, Division of Urology, Department of Surgery and Division of Surgical Oncology, Department of Oncology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON, Canada; Division of Surgical Oncology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON

Linda Nott, Division of Urology, Department of Surgery and Division of Surgical Oncology, Department of Oncology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON, Canada

Stephen E. Pautler, Division of Urology, Department of Surgery and Division of Surgical Oncology, Department of Oncology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON, Canada; Division of Surgical Oncology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON

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How to Cite

Dion, M., Martínez, C. H., Williams, A. K., Chalasani, V., Nott, L., & Pautler, S. E. (2013). Cost analysis of two follow-up strategies for localized kidney cancer: a Canadian cohort comparison. Canadian Urological Association Journal, 4(5), 322–6. https://doi.org/10.5489/cuaj.904

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Original Research