Cost comparison of nephron-sparing treatments for cT1a renal masses
Cost comparison of nephron-sparing treatments for cT1a renal masses
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DOI：
10.1016/j.urolonc.2012.01.006
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发表时间：
2013-10-01
影响因子：
2.7
通讯作者：
Leveillee, Raymond J.
中科院分区：
文献类型：
--
作者：
Castle, Scott M.;Gorbatiy, Vladislav;Leveillee, Raymond J.
目的：小肾肿瘤的治疗选择已经从根治性肾切除术（RN）发展到肾部分切除术（PN）、热消融或主动监测。随着技术的进步，成本差异不明显。本研究的目的是比较6个月的成本与保留肾单位的程序为CT 1a renal tumors.Materials和方法：我们进行了审查的患者诊断为一个孤立的CT 1a肾肿块谁接受手术治疗，从2008年6月至2011年5月。对173例患者进行了开放性肾部分切除术（OPN）、机器人辅助肾部分切除术（RLPN）、腹腔镜射频消融术（LRFA）或计算机断层扫描引导射频消融术（CTRFA）。收集手术费用、相关住院时间和术后6个月的费用数据。结果：患者接受手术，包括52例OPN、48例RLPN、44例LRFA和29例CTRFA。OPN、RLPN、LRFA和CTRFA的中位相关总成本分别为17，018美元、20，314美元、13，965美元和6，475美元。单变量分析中，按手术方式分层时，总费用（P < 0.001）、手术室（OR）时间（P < 0.001）、手术供应（P < 0.001）和食宿（P < 0.001）存在差异。多元线性回归分析（R-2 = 0.966）显示手术方式（P = 0.007）、住院时间（P < 0.001）和手术时间（P < 0.001）是总费用的显著预测因素。然而，肿瘤的大小（P = 0.175），和Charlson合并症指数（P = 0.078）没有统计学意义。结论：6个月的肾单位保留手术的成本是最低的射频消融术（RFA）无论是腹腔镜或计算机断层扫描（CT）引导的方法相比，RLPN和OPN。随着肿瘤学和安全性结局的改善，并且在所有保留肾单位手术（NSS）方法中变得相当，每个手术的成本将开始在临床和医疗保健政策制定中发挥更大的作用。(c)2013 Elsevier Inc. All rights reserved.
Objectives: Treatment options for small renal tumors have evolved from radical nephrectomy (RN) to partial nephrectomy (PN), thermal ablation, or active surveillance. With the advancement of techniques, costs differences are unclear. The objective of this study is to compare the 6-month costs associated with nephron-sparing procedures for cT1a renal tumors.Materials and methods: We performed a review of patients diagnosed with a solitary cT1a renal mass who underwent surgical treatment from June 2008 to May 2011. Open partial nephrectomy (OPN), robot-assisted partial nephrectomy (RLPN), laparoscopic radio-frequency ablation (LRFA), or computed tomography guided radio frequency ablation (CTRFA) was performed on 173 patients. Cost data were collected for surgical costs, associated hospital stay, and the 6-month postoperative period.Results: Patients underwent surgery, including 52 OPN, 48 RLPN, 44 LRFA, and 29 CTRFA. Median total costs associated were $17,018, $20,314, $13,965, and $6,475, for OPN, RLPN, LRFA, and CTRFA, respectively. When stratified by approach differences were noted for total cost (P < 0.001), operating room (OR) time (P < 0.001), surgical supply (P < 0.001), and room and board (P < 0.001) in univariable analysis. Multivariable linear regression (R-2 = 0.966) showed surgical approach (P = 0.007), length of stay (P < 0.001), and OR time (P < 0.001) to be significant predictors of total cost. However, tumor size (P = 0.175), and Charlson comorbidity index (P = 0.078) were not statistically significant.Conclusions: Six-month cost of nephron-sparing surgery is lowest with radio frequency ablation (RFA) by either laparoscopic or computed tomography (CT)-guided approach compared to RLPN and OPN. As oncologic and safety outcomes improve and become comparable in all nephron-sparing surgery (NSS) approaches, cost of each procedure will start to play a stronger role in the clinical and healthcare policy setting. (c) 2013 Elsevier Inc. All rights reserved.