Ablation of small renal cancer associated with “significantly lower costs” than either partial or radical nephrectomy

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For older patients with small (T1a) renal cancer, percutaneous ablation is associated with much lower costs than partial or radical nephrectomy, both at the time of treatment and through the first year after treatment, new research has shown.

The economic analysis of percutaneous ablation vs. surgery for small renal cancers, was presented at the World Conference on Interventional Oncology (WCIO, 9–12 June 2016, Boston, USA). The research was undertaken by investigators in New York, Madison and Seattle in the USA.

“Percutaneous thermal ablation is a minimally-invasive, nephron-sparing alternative to partial nephrectomy or radical nephrectomy for some patients with small renal cancers. Our objective was to compare costs associated with each procedure through the first year after treatment in a population-based cohort of older adults,” said Adam D Talenfeld, an interventional radiologist in Weill Cornell Medicine, New York, USA at WCIO.

The investigators used a Medicare dataset to identify patients aged 66 years or older who received ablation, radical nephrectomy or partial nephrectomy within six months of diagnosis of a clinically-staged T1a renal cancer in the period 2006 to 2011. They defined cost as the amount reimbursed by Medicare on all inpatient, outpatient, physician, durable medical equipment, home health, and hospice claims. The researchers analysed treatment costs and cumulative costs at 30 days, 90 days, and 365 days after treatment. The inpatient treatment costs comprised of all reimbursements from index admissions plus carrier claims for the day of treatment. Outpatient treatment costs were defined as all claims on the day of treatment. Cumulative 365-day costs were defined as all payments made by Medicare in the 365-day period beginning with the day of treatment.

Talenfeld and colleagues identified pre-existing conditions in Medicare claims in the year prior to cancer diagnosis. They used multivariable log-linear regression to estimate associations between treatment approach and costs, controlling for demographic and health characteristics.

There were 460, 1,626 and 2,336 patients treated with ablation, partial nephrectomy and radical nephrectomy, respectively. They found that median treatment costs were US$4,265, US$14,412 and US$14,710 for ablation, partial nephrectomy and radical nephrectomy, respectively. Median cumulative costs at 365 days post-procedure were US$12,590, US$21,702 and US$23,063.

“Controlling for demographic and disease characteristics, both treatment costs and one-year costs were significantly lower for patients treated with ablation compared to either partial nephrectomy or radical nephrectomy (p<0.0001),” Talenfeld said.

Costs increased with increasing patient age. Controlling for treatment and baseline characteristics, one year costs were significantly higher in patients with greater Charlson comorbidity scores and those with diabetes at baseline. Both treatment costs and one-year costs were greater in patients with baseline renal insufficiency or cardiovascular disease (p<0.001). Treatment costs decreased from 2006 through 2011 for all procedure types, he added.

Talenfeld and colleagues concluded: “From the payer perspective, ablation for older patients with T1a renal cancer is associated with significantly lower costs than partial nephrectomy or radical nephrectomy, both at the time of treatment and through the first year after treatment.”

They further concluded that in well-selected patients with small tumours, ablation may be a less costly alternative to surgery.