Percutaneous Cryoablation versus Robot-Assisted Partial Nephrectomy of Renal T1A Tumors: a Single-Center Retrospective Cost-Effectiveness Analysis.

Autor: Garcia RG; Center of Interventional Medicine, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627- 4º andar - Bloco B, São Paulo, SP, 05652-900, Brazil., Katz M; Department of Cardiology, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627- 4o andar - Bloco A1, São Paulo, SP, 05652-900, Brazil., Falsarella PM; Center of Interventional Medicine, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627- 4º andar - Bloco B, São Paulo, SP, 05652-900, Brazil. primina@gmail.com., Malheiros DT; Value Management Office, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627- 8º andar- bloco D, São Paulo, SP, 05652-900, Brazil., Fukumoto H; Financial Division, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627- 3º andar - Bloco E, São Paulo, SP, 05652-900, Brazil., Lemos GC; Urology Department, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627- 4 andar - Bloco E, São Paulo, SP, 05652-900, Brazil., Teich V; Healthy Economics Division, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627- 8 andar - Bloco D, São Paulo, SP, 05652-900, Brazil., Salvalaggio PR; Abdominal Surgery Division & Albert, Einstein Medical School, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627- 1oSS - Bloco A, São Paulo, SP, 05652-900, Brazil.
Jazyk: angličtina
Zdroj: Cardiovascular and interventional radiology [Cardiovasc Intervent Radiol] 2021 Jun; Vol. 44 (6), pp. 892-900. Date of Electronic Publication: 2021 Jan 03.
DOI: 10.1007/s00270-020-02732-x
Abstrakt: 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.
Databáze: MEDLINE
Externí odkaz: