Abstract No. 467 Analysis of healthcare cost and resource utilization associated with thermal ablation of renal cell carcinoma

Abstract

To compare hospital expenditures and resource utilization associated with radiofrequency (RFA), cryoablation (CA), and microwave (MWA) for cT1N0M0 renal cell carcinoma (RCC) A retrospective evaluation was conducted in 470 of computer tomography (CT)-guided thermal ablations of biopsy-proven RCC treated with between October 2006 and June 2019. Components of direct and indirect costs were tabulated and compared across the three different ablation modalities. Deterministic sensitivity analysis was performed to evaluate the effect of the individual cost components in the overall cost of ablative treatment. In-hospital resource utilization incurred from the start of the procedure to 30 days after hospital discharge was examined for each ablative technique. Continuous variables were analyzed using the one-way ANOVA test, and categorical variables were analyzed using Pearson’s chi-squared test and the Kruskal-Wallis test. A total of 470 T1N0M0 RCCs with a mean size of 3.2 cm (range, 0.5–6.9 cm) were treated with MWA (n = 86, 18%), RFA (n = 344, 73%) or CA (n = 40, 9%). Baseline patient or tumor characteristics did not differ significantly between the three groups. The median cost of MWA was significantly lower than that of RFA and CA with a cost advantage of $3835 and $2714, respectively (P = 0.0001). The number of ablation probes used was a major determinant of the overall cost, and MWA used the least number of probes (P = 0.0001). Additionally, MWA was associated with the lowest utilization of procedure room time, anesthesia medications, and radiation dose when compared to RFA and CA (P = 0.001, P = 0.001, and P = 0.001, respectively). Hospital spending and resource utilization in the 30 days immediately after the procedure are similar among the three ablative techniques. Microwave ablation is associated with lowest procedural costs and resource utilization compared to RFA and CA for the treatment of T1 RCC. These findings may incentivize wider use of MWA to optimize value-based care in ablation practice.