Comparison of health economics in robot-assisted partial nephrectomy and CT-guided cryoablation for the management of T1 renal cell carcinoma: an analysis of a prospective Danish cohort

PURPOSE: This study used real-world outcomes data to compare the cost-effectiveness of percutaneous cryoablation (PCA) and robot-assisted partial nephrectomy (RAPN) in patients with T1 renal cell carcinoma (RCC).

MATERIALS AND METHODS: Prospective data from June 2019 to February 2021 from two Danish University hospitals, following patients with RCC stage T1 treated with either PCA or RAPN, were used to provide procedural and clinical outcome parameters. A Markov model was used to estimate quality-adjusted life years (QALYs) and costs, incorporating health states for stable disease, local recurrence, metastasis, and all-cause mortality. Propensity score matching using specific covariates was carried out to ensure that the two populations evaluated were matched. Analyses were conducted comparing time to local recurrence or metastases, duration of hospital stay, and postoperative complications. Treatment-specific mortality was not included in the model due to the low number of deaths observed.

RESULTS: There were no significant differences between PCA and RAPN in terms of local recurrence (HR = 0.80; 95% CI = 0.34-1.85; p = 0.72), metastases (HR = 2.09; 95% CI = 0.69-6.26; p = 0.19), or Clavien-Dindo III + complications (5.5% vs 2.5%; p = 0.325). There were significant differences in the mean duration of hospital stay (1.13 days versus 1.90 days; p < 0.001). QALYs gained were nearly identical for each treatment; however, PCA was associated with a net monetary benefit of €9,045 at a willingness-to-pay threshold of €40,000/QALY.

CONCLUSION: The present study suggests that PCA could equally benefit patients with RCC T1 by providing cost savings, making it a more cost-effective treatment without compromising oncological outcomes.

LEVEL OF EVIDENCE: 2b, Analysis based on clinically sensible costs or alternatives, including multi-way sensitivity analyses.