To evaluate the cost-effectiveness of percutaneous cryoablation (PCA) versus robot-assisted partial nephrectomy (RPN) in patients with small renal tumors (T1a stage), considering perioperative complications.
Retrospective study from November 2008 to April 2017 of 122 patients with a T1a renal mass who after being analyzed by a multidisciplinary board underwent to PCA (59 patients) or RPN (63 patients). Hospital costs in US dollars, and clinical and tumor data were compared. Non-complicated intervention was considered as an effective outcome. A hypothetical model of possible complications based on Clavien-Dindo classification (CDC) was built, grouping them into mild (CDC I and II) and severe (CDC III and IV). A decision tree model was structured from complications of published data.
Patients who underwent PCA were older (62.5 vs. 52.8 years old, p < 0.001), presented with more coronary disease and previous renal cancer (25.4% vs. 10.1%, p = 0.023 and 38% vs. 7.2%, p < 0.001, respectively). Patients treated with PCA had a higher preoperative risk (American Society of Anesthesiologists-ASA ≥ 3) than those in the RPN group (25.4% vs. 0%, p < 0.001). Average operative time was significantly lower with PCA than RPN (99.92 ± 29.05 min vs. 129.28 ± 54.85 min, p < 0.001). Average hospitalization time for PCA was 2.2 ± 2.95 days, significantly lower than RPN (mean 3.03 ± 1.49 days, p = 0.04). The average total cost of PCA was significantly lower than RPN (US$12,435 ± 6,176 vs. US$19,399 ± 6,047, p < 0.001). The incremental effectiveness was 5% higher comparing PCA with RPN, resulting a cost-saving result in favor of PCA.
PCA was the dominant strategy (less costly and more effective) compared to RPN, considering occurrence of perioperative complications.
Cardiovascular and interventional radiology. 2021 Jan 03 [Epub ahead of print]
Rodrigo Gobbo Garcia, Marcelo Katz, Priscila Mina Falsarella, Daniel Tavares Malheiros, Helena Fukumoto, Gustavo Caserta Lemos, Vanessa Teich, Paolo Rogério Salvalaggio
Center of Interventional Medicine, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627- 4º andar - Bloco B, São Paulo, SP, 05652-900, Brazil., Department of Cardiology, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627- 4o andar - Bloco A1, São Paulo, SP, 05652-900, Brazil., Center of Interventional Medicine, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627- 4º andar - Bloco B, São Paulo, SP, 05652-900, Brazil. ., Value Management Office, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627- 8º andar- bloco D, São Paulo, SP, 05652-900, Brazil., Financial Division, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627- 3º andar - Bloco E, São Paulo, SP, 05652-900, Brazil., Urology Department, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627- 4 andar - Bloco E, São Paulo, SP, 05652-900, Brazil., Healthy Economics Division, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627- 8 andar - Bloco D, São Paulo, SP, 05652-900, Brazil., Abdominal Surgery Division & Albert, Einstein Medical School, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627- 1oSS - Bloco A, São Paulo, SP, 05652-900, Brazil.