Category: Laparoscopic/ Robotic: Other
Introduction & Objective : To improve value in healthcare, physicians must understand outcomes and costs for clinical conditions. Several treatments for small renal masses exist and surgical and oncologic outcomes comparing these methods are commonly reported. Few reports exist comparing the costs of these procedures. Reported data is often based on estimated or approximated costs or charges. We sought to compare the relative costs of robotic partial nephrectomy (RPN), laparoscopic partial nephrectomy (LPN), and laparoscopic cryoablation (LCA) for treatment of T1a renal masses using a proprietary costing tool called Value Driven Outcomes (VDO).
Methods : We retrospectively collected data on patients with T1a (<4 cm) renal masses who underwent surgical treatment between 12/2010 and 2/2016 by a single surgeon (BDH). Demographic data and all treatment-related costs per patient incurred within 90 days of surgery were collected. The VDO tool was used to collect and compare the relative total and component cost of each procedure. VDO is a proprietary, peer-reviewed cost-analysis tool developed by the University of Utah Health (UUH) system that measures category-specific costs related to every patient encounter within the UUH. Comparisons were made by assigning RPN as the reference.
Results : 56 subjects were included with 22, 20, and 14 patients in the RPN, LCA, and LPN groups. Final pathology, mean tumor size, and complication rates were similar between groups. Cancer specific survival was 100% for all groups. Mean length of stay was shorter for LCA, 1.4 days compared with 2.6 for RPN and 3.6 for LPN. Total mean relative cost was 0.86 for LPN, 1.0 for RPN, and 1.72 for LCA. LCA had the lowest facility utilization cost (0.71) when compared to LPN (0.91), and RPN. However, intraoperative supply costs were 1.93 for LCA and 0.56 for LPN. Supplies made up 70% of the total cost of LCA, compared with 20% for LPN, and 25% for RPN. Laboratory and medication costs did not contribute significantly to the total cost when compared with facility and supply costs.
Conclusions : Clinical outcomes are similar when comparing these 3 surgical treatments in this series. LCA had the highest mean cost per treatment, 72% more expensive than RPN and 100% more than LPN. The cost of disposable supplies (cryoprobes) was the primary driver for this cost difference despite a lower facility utilization cost. LPN was 14% less expensive than RPN, because of lower supply costs for LPN. Using the VDO tool as part of medical decision-making provides valuable insights into improving the value of healthcare delivery on a system level.