PD25-06 PERCUTANEOUS MICROWAVE ABLATION VS PARTIAL NEPHRECTOMY FOR SMALL RENAL MASSES: COST-EFFECTIVENESS ANALYSIS

Abstract

You have accessJournal of UrologyHealth Services Research: Value of Care: Cost and Outcomes Measures II (PD25)1 Sep 2021PD25-06 PERCUTANEOUS MICROWAVE ABLATION VS PARTIAL NEPHRECTOMY FOR SMALL RENAL MASSES: COST-EFFECTIVENESS ANALYSIS Clinton Yeaman, Lauren O'Connor, Jennifer Lobo, Anthony DeNovio, Christopher Ballantyne, and Noah Schenkman Clinton YeamanClinton Yeaman More articles by this author , Lauren O'ConnorLauren O'Connor More articles by this author , Jennifer LoboJennifer Lobo More articles by this author , Anthony DeNovioAnthony DeNovio More articles by this author , Christopher BallantyneChristopher Ballantyne More articles by this author , and Noah SchenkmanNoah Schenkman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002018.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To perform a cost-effective analysis using a Markov model between percutaneous microwave ablation (MWA) and partial nephrectomy (PN) for treatment of small renal masses using both literature values and institutional outcome data. METHODS: We created a decision analytic Markov model depicting management of the small renal mass (percutaneous MWA vs robotic-assisted PN) incorporating costs, health utilities, and probabilities of complications and recurrence as model inputs from the literature. Iterations of the model were also cycled using our institutional outcome and financial data and various patient characteristics based on our IRB approved small renal mass database. Modeling was performed using Treeage (2020.2.1). A willingness to pay (WTP) threshold of $75,000 was used. RESULTS: Percutaneous MWA was the preferred treatment modality. MWA dominated RA-PN, meaning it resulted in more quality adjusted life years (QALYs) at a lower cost. Model inputs are shown in Table 1 and the model decision tree is shown in Figure 1. Cost-effectiveness analysis revealed an Incremental Cost Effectiveness Ratio (ICER) of -$6,847 per quality adjusted life-year (QALY). The model revealed a mean cost of MWA of $12,921 and 12.5 QALYs. Robotic-assisted PN had a mean cost of $21,477 and 11.2 QALYs. Sensitivity analysis was performed for all variables. Patient age of 39 years or younger resulted in RA-PN being favored over MWA. Both MWA and RA-PN are cost-effective approaches under this condition, but RA-PN is preferred at the WTP threshold. Relative preference of MWA was robust to sensitivity analysis of all other variables. Cost of PN and patient age had the most dramatic impact on ICER. It was more cost-effective if local recurrence was managed with MWA rather than partial or radical nephrectomy. CONCLUSIONS: Cost-effectiveness analysis demonstrates MWA is the preferred treatment of small renal masses when compared with RA-PN and accounting for complication and recurrence risk. Source of Funding: N/A © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e433-e434 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Clinton Yeaman More articles by this author Lauren O'Connor More articles by this author Jennifer Lobo More articles by this author Anthony DeNovio More articles by this author Christopher Ballantyne More articles by this author Noah Schenkman More articles by this author Expand All Advertisement Loading ...