1526 ECONOMIC AND CLINICAL CONSEQUENCES OF NEW ONSET POST-OPERATIVE CHRONIC KIDNEY DISEASE FOLLOWING RADICAL AND PARTIAL NEPHRECTOMY IN THE MANAGEMENT OF SMALL RENAL MASSES

Abstract

You have accessJournal of UrologyKidney Cancer: Localized1 Apr 20111526 ECONOMIC AND CLINICAL CONSEQUENCES OF NEW ONSET POST-OPERATIVE CHRONIC KIDNEY DISEASE FOLLOWING RADICAL AND PARTIAL NEPHRECTOMY IN THE MANAGEMENT OF SMALL RENAL MASSES Steven L Chang, Lauren E Cipriano, Steven M Brunelli, and Benjamin I Chung Steven L ChangSteven L Chang Boston, MA More articles by this author , Lauren E CiprianoLauren E Cipriano Stanford, CA More articles by this author , Steven M BrunelliSteven M Brunelli Boston, MA More articles by this author , and Benjamin I ChungBenjamin I Chung Stanford, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1519AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES New onset post-operative chronic kidney disease (po-CKD), defined as a glomerular filtration rate of <60mL/min/1.73m2, is a recognized adverse outcome after extirpative therapy for small renal masses (SRM, ≤4cm) in patients with normal renal function pre-operatively. We quantified the long-term economic and clinical consequences of po-CKD following radical and partial nephrectomy for the management of SRM. METHODS Using a Markov model, we evaluated open and laparoscopic approaches to radical and partial nephrectomy in the treatment of SRMs. The base case was a 65-year old healthy individual with a unilateral SRM and normal renal function. We used a 3-month cycle length, lifetime horizon, societal perspective, and 3% discount rate. The costs, quality of life adjustments, and transition probabilities were estimated from the literature, Centers for Medicare & Medicaid Services, and expert opinion. Health outcomes were measured in quality-adjusted life-years (QALY) gained and costs in 2008 US dollars. The model was tested with sensitivity analyses. RESULTS The average discounted lifetime outcomes are listed in the Table. There were minimal differences between the open and laparoscopic approaches. Radical versus partial nephrectomy led to a substantially higher costs and modestly poorer quality-adjusted survival. The vast majority of these differences were attributable to po-CKD. The impact of po-CKD was indirectly associated with age. Results of the base case and sensitivity analyses for radical and partial nephrectomy. Age at Surgery 55-year old 65-year old 75-year old Overall Medical Expenditures (2008 US$) Radical Nephrectomy $244,970 $192,246 $127,022 Partial Nephrectomy $187,843 $147,031 $99,125 Difference (Radical vs Partial) +$57,127 +$45,215 +$27,897 Health Outcomes (QALYs) Radical Nephrectomy 11.46 8.72 5.98 Partial Nephrectomy 12.15 9.35 6.46 Difference (Radical vs Partial) -0.69 -0.63 -0.48 Lifetime Probability of po-CKD Radical Nephrectomy 90% 83% 71% Partial Nephrectomy 66% 55% 40% Difference (Radical vs Partial) +24% +28% +31% Additional Cost Attributable to po-CKD (2008 US$) Radical Nephrectomy $140,250 $100,325 $56,028 Partial Nephrectomy $87,470 $58,475 $31,509 Difference (Radical vs Partial) +$52,870 +$41,850 +$24,519 Health Outcome Attributable to po-CKD (QALYs-gained) Radical Nephrectomy -1.83 -1.46 -0.97 Partial Nephrectomy -1.17 -0.85 -0.52 Difference (Radical vs Partial) -0.66 -0.61 -0.45 CONCLUSIONS Partial nephrectomy provides cost-savings and improved health outcomes compared to radical nephrectomy in the management of patients with SRMs across all age groups. There were minimal differences between open and laparoscopic approaches in long-term outcomes. Both procedures incur significant economic and clinical costs due to the development of po-CKD. A discussion about the potential for po-CKD should be incorporated into the informed consent for surgical treatments of SRMs. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e612-e613 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Steven L Chang Boston, MA More articles by this author Lauren E Cipriano Stanford, CA More articles by this author Steven M Brunelli Boston, MA More articles by this author Benjamin I Chung Stanford, CA More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...