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Cost-effectiveness analysis: percutaneous microwave ablation vs robotic-assisted partial nephrectomy for small renal masses

  • Kidneys, Ureters, Bladder, Retroperitoneum
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

The majority of newly diagnosed renal tumors are masses < 4 cm in size with treatment options, including active surveillance, partial nephrectomy, and ablative therapies. The cost-effectiveness literature on the management of small renal masses (SRMs) does not account for recent advances in technology and improvements in technical expertise. We aim to perform a cost-effectiveness analysis for percutaneous microwave ablation (MWA) and robotic-assisted partial nephrectomy (RA-PN) for the treatment of SRMs.

Methods

We created a decision analytic Markov model depicting management of the SRM incorporating costs, health utilities, and probabilities of complications and recurrence as model inputs using TreeAge. A willingness to pay (WTP) threshold of $100,000 and a lifetime horizon were used. Probabilistic and one-way sensitivity analyses were performed.

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. Cost-effectiveness analysis revealed a negative Incremental Cost-Effectiveness Ratio (ICER), indicating dominance of MWA. The model revealed MWA had a mean cost of $8,507 and 12.51 QALYs. RA-PN had a mean cost of $21,521 and 12.43 QALYs. Relative preference of MWA was robust to sensitivity analysis of all other variables. Patient starting age and cost of RA-PN had the most dramatic impact on ICER.

Conclusion

MWA is more cost-effective for the treatment of SRM when compared with RA-PN and accounting for complication and recurrence risk.

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Abbreviations

AS:

Active surveillance

ICER:

Incremental cost-effectiveness ratio

MWA:

Microwave ablation

NMB:

Net monetary benefit

QALYs:

Quality-adjusted life years

RA-PN:

Robotic-assisted partial nephrectomy

SRM:

Small renal mass

WTP:

Willingness to pay

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Funding

No funds, grants, or other support were received. The authors have no relevant financial or non-financial interests to disclose.

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Author notes

  1. Lauren O’Connor

    Present address: Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, USA

Authors and Affiliations

  1. Department of Urology, UVA Medical Center, University of Virginia, Fontaine Research Park, 500 Ray C. Hunt Drive, 1215 Lee Street, Charlottesville, VA, 22908, USA

    Clinton Yeaman, Jennifer M. Lobo, Christopher Ballantyne & Noah Schenkman

  2. Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, VA, USA

    Jennifer M. Lobo, Lauren O’Connor & Tanya Wanchek

  3. School of Medicine, University of Virginia, Charlottesville, VA, USA

    Rebecca Marchant & Anthony DeNovio

  4. Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, USA

    Drew L. Lambert & Ayman Mithqal

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Contributions

CY participated in the project development, data analysis, interpretation of data, and manuscript writing/editing, RM participated in the data collection or management and manuscript writing/editing, JML participated in the project development, data analysis, interpretation of data, and manuscript writing/editing, ADN participated in the data collection or management and manuscript writing/editing, LOC participated in the data collection or management and manuscript writing/editing, TW participated in the project development, data analysis, interpretation of data, and manuscript writing/editing, CB participated in the interpretation of data and manuscript writing/editing, DLL participated in the interpretation of data and manuscript writing/editing, AM participated in the interpretation of data and manuscript writing/editing, NSS participated in the project development, Interpretation of data, and manuscript writing/editing, All authors meet criteria for definitions of authorship as defined by ICMJE.

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Correspondence to Clinton Yeaman.

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Yeaman, C., Marchant, R., Lobo, J.M. et al. Cost-effectiveness analysis: percutaneous microwave ablation vs robotic-assisted partial nephrectomy for small renal masses. Abdom Radiol 48, 411–417 (2023). https://doi.org/10.1007/s00261-022-03692-1

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  • DOI: https://doi.org/10.1007/s00261-022-03692-1

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