Percutaneous Cryoablation versus Robot-Assisted Partial Nephrectomy of Renal T1A Tumors: a Single-Center Retrospective Cost-Effectiveness Analysis.
Cardiovasc Intervent Radiol
; 44(6): 892-900, 2021 Jun.
Article
en En
| MEDLINE
| ID: mdl-33388867
PURPOSE: To evaluate the cost-effectiveness of percutaneous cryoablation (PCA) versus robot-assisted partial nephrectomy (RPN) in patients with small renal tumors (T1a stage), considering perioperative complications. MATERIALS AND METHODS: Retrospective study from November 2008 to April 2017 of 122 patients with a T1a renal mass who after being analyzed by a multidisciplinary board underwent to PCA (59 patients) or RPN (63 patients). Hospital costs in US dollars, and clinical and tumor data were compared. Non-complicated intervention was considered as an effective outcome. A hypothetical model of possible complications based on Clavien-Dindo classification (CDC) was built, grouping them into mild (CDC I and II) and severe (CDC III and IV). A decision tree model was structured from complications of published data. RESULTS: Patients who underwent PCA were older (62.5 vs. 52.8 years old, p < 0.001), presented with more coronary disease and previous renal cancer (25.4% vs. 10.1%, p = 0.023 and 38% vs. 7.2%, p < 0.001, respectively). Patients treated with PCA had a higher preoperative risk (American Society of Anesthesiologists-ASA ≥ 3) than those in the RPN group (25.4% vs. 0%, p < 0.001). Average operative time was significantly lower with PCA than RPN (99.92 ± 29.05 min vs. 129.28 ± 54.85 min, p < 0.001). Average hospitalization time for PCA was 2.2 ± 2.95 days, significantly lower than RPN (mean 3.03 ± 1.49 days, p = 0.04). The average total cost of PCA was significantly lower than RPN (US$12,435 ± 6,176 vs. US$19,399 ± 6,047, p < 0.001). The incremental effectiveness was 5% higher comparing PCA with RPN, resulting a cost-saving result in favor of PCA. CONCLUSION: PCA was the dominant strategy (less costly and more effective) compared to RPN, considering occurrence of perioperative complications.
Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Análisis Costo-Beneficio
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Criocirugía
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Procedimientos Quirúrgicos Robotizados
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Neoplasias Renales
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Nefrectomía
Tipo de estudio:
Health_economic_evaluation
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Límite:
Humans
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Male
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Middle aged
Idioma:
En
Revista:
Cardiovasc Intervent Radiol
Año:
2021
Tipo del documento:
Article
País de afiliación:
Brasil
Pais de publicación:
Estados Unidos