scholarly journals Cost-utility analysis of radical nephrectomy versus partial nephrectomy in the management of small renal masses: adjusting for the burden of ensuing chronic kidney disease

2013 ◽  
Vol 7 (3-4) ◽  
pp. 108-13 ◽  
Author(s):  
Zachary Klinghoffer ◽  
Jean-Eric Tarride ◽  
Giacomo Novara ◽  
Vincenzo Ficarra ◽  
Anil Kapoor ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Partial Nephrectomy ◽  
Radical Nephrectomy ◽  
Cost Utility ◽  
Sensitivity Analyses ◽  
Decision Analysis Model ◽  
Complication Rates ◽  
Small Renal Masses ◽  
Renal Masses

Objectives: To compare the cost-utility of laparoscopic radical nephrectomy (LRN), laparoscopic partial nephrectomy (LPN) and open partial nephrectomy (OPN) in the management of small renal masses (SRMs) when the impact of ensuing chronic kidney disease (CKD) disease is considered. Methods: We designed a Markov decision analysis model with a 10-year time horizon. Estimates of costs, utilities, complication rates and probabilities of developing CKD were derived from the literature. The base case patient was assumed to be a 65-year-old patient with a <4 cm unilateral renal mass, a normal contralateral kidney and a normal pre-operative serum creatinine. Univariate and probabilistic sensitivity analyses were conducted to address the uncertainty associated with the study parameters. Results: OPN was the least costly strategy at $25941 USD and generated 7.161 QALYs over 10 years. LPN yielded 0.098 additional QALYs at an additional cost of $888 for an incremental cost-effectiveness ratio of $9057 per QALY, well below a commonly cited willingness-to-pay threshold of $50000 per QALY. LRN was more costly and yielded fewer QALYs than OPN and LPN. Sensitivity analyses demonstrated our model to be robust to changes to key parameters. Age had no effect on preferred strategy. Conclusions: Partial nephrectomy (PN) is the preferred treatment strategy for SRMs. In centers where LPN is not available, OPN remains considerably more cost-effective than LRN. Furthermore, our study demonstrates that there is no age at which PN is not preferred to LRN. Our study provides additional evidence to advocate PN for the management of all amenable SRMs.

Robotic Partial Nephrectomy for Small Renal Masses in Patients With Pre-existing Chronic Kidney Disease

Urology ◽  
2012 ◽  
Vol 80 (4) ◽  
pp. 845-851 ◽  
Author(s):  
Julien Guillotreau ◽  
Rachid Yakoubi ◽  
Jean-Alexandre Long ◽  
Joseph Klink ◽  
Riccardo Autorino ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Partial Nephrectomy ◽  
Robotic Partial Nephrectomy ◽  
Small Renal Masses ◽  
Renal Masses

The economic and clinical costs of chronic kidney disease following radical and partial nephrectomy in the management of small renal masses.

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 353-353
Author(s):  
S. L. Chang ◽  
L. E. Cipriano ◽  
L. C. Harshman ◽  
B. I. Chung
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Health Outcomes ◽  
Partial Nephrectomy ◽  
Base Case ◽  
Small Renal Masses ◽  
Renal Masses ◽  
Lifetime Horizon ◽  
Life Years ◽  
The Impact

353 Background: Postoperative chronic kidney disease (PCKD), defined as a glomerular filtration rate of < 60mL/min/1.73m2, is a recognized adverse outcome after extirpative therapy for small renal masses (SRM, ≤ 4cm). We quantified the long-term economic and clinical costs of PCKD following radical and partial nephrectomy for the management of SRM. Methods: Using a Markov model, we evaluated open and laparoscopic approaches for radical and partial nephrectomy in the treatment of SRMs. The base case was a 65-year old healthy individual with a unilateral SRM and normal renal function. We used a 3-month cycle length, lifetime horizon, societal perspective, and 3% discount rate. The costs, quality of life adjustments, and transition probabilities were estimated from the literature, Medicare, and expert opinion. Health outcomes were measured in quality-adjusted life-years (QALY) gained and costs in 2008 U.S. dollars. The model was tested with sensitivity analyses. Results: The average discounted lifetime outcomes are listed in the Table. There were minimal differences between the open and laparoscopic approaches. PCKD led to a substantial increase costs and decrease in health outcomes. The impact of PCKD was indirectly associated with age. Conclusions: Partial nephrectomy provides cost-savings and improved health outcomes compared to radical nephrectomy in the management of patients with SRMs. Both procedures incur significant economic and clinical costs due to the development of PCKD. A discussion about the potential for PCKD should be incorporated into the informed consent for surgical treatment of SRMs. [Table: see text] No significant financial relationships to disclose.

1111 ROBOTIC PARTIAL NEPHRECTOMY FOR SMALL RENAL MASSES IN PATIENTS WITH PRE-EXISTING CHRONIC KIDNEY DISEASE

2012 ◽  
Vol 187 (4S) ◽  
Author(s):  
julien guillotreau ◽  
rachid yakoubi ◽  
joseph klink ◽  
riccardo autorino ◽  
jean alexandre Long ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Partial Nephrectomy ◽  
Robotic Partial Nephrectomy ◽  
Small Renal Masses ◽  
Renal Masses

scholarly journals Cardiovascular outcomes in kidney cancer patients

2017 ◽  
Vol 10 (1_suppl) ◽  
pp. 24-28
Author(s):  
Elsie Ellimah Mensah ◽  
Luke Hounsome ◽  
Julia Verne ◽  
Roger Kockelbergh ◽  
Erik Mayer
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
General Population ◽  
Partial Nephrectomy ◽  
Radical Nephrectomy ◽  
Significant Risk ◽  
Cancer Registration ◽  
Event Analysis ◽  
Co Morbidity ◽  
Renal Tumours

Introduction: In the surgical management of small renal tumours, current guidelines recommend that partial nephrectomy should be the preferred option wherever possible. This is based on evidence suggesting improved quality of life outcomes, morbidity and mortality and equivalent oncological outcomes when compared with radical nephrectomy. Chronic kidney disease is a significant risk factor for cardiovascular disease and subsequent mortality. This study explored differences in cardiac-related events and co-morbidity, using linked registry data for patients undergoing radical or partial nephrectomy for T1 renal tumours. Methods: Data from the National Cancer Registration Service was searched to identify T1 renal cancer diagnoses between 1999 and 2012. This data was matched against hospital episode statistics to identify those patients who had undergone radical or partial nephrectomy between 1999 and 2013 using OPCS codes. Data was collected on cardiac-related admissions and deaths in nephrectomy patients. Equivalent data was also collected for the general population to allow age-standardized comparison. Charlson score was used as a proxy for pre-operative co-morbidity. Results: Radical/partial nephrectomy patients had a greater risk of cardiac-related admissions compared with the general population (relative risk (RR) 3.32, 95% confidence interval (CI) 3.24–3.40), but with no increase in cardiac-related deaths (RR 0.84, 95% CI 0.70–1.01). There was no difference in the admission risk, or death, comparing radical or partial nephrectomy for T1 renal tumours (RR 1.02, 95% CI 0.88–1.17) using ‘time to event’ analysis. There was no difference in the comorbidity index between radical nephrectomy and partial nephrectomy patients. Conclusion: The higher incidence of cardiac-related admissions seen for radical/partial nephrectomy patients may be explained by a higher proportion of patients with medical illnesses including cardiovascular risk factors (hypertension, diabetes) undergoing renal imaging. The absence of a difference between the radical nephrectomy and partial nephrectomy groups supports the phenomenon of surgically-induced chronic kidney disease, which may not have the same morbidity implications as medically-induced chronic kidney disease.

scholarly journals Renal functional outcomes after surgery for renal cortical tumors

2015 ◽  
Vol 2 (2) ◽  
pp. 45-54 ◽  
Author(s):  
Danny Lascano ◽  
Julia B Finkelstein ◽  
G. Joel DeCastro ◽  
James M McKiernan
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Renal Disease ◽  
Partial Nephrectomy ◽  
Functional Outcomes ◽  
Surgical Techniques ◽  
Renal Tumors ◽  
Renal Masses ◽  
Nephron Sparing ◽  
Surgically Induced

Historically, radical nephrectomy represented the gold standard for the treatment of small (? 4cm) as well as larger renal masses.  Recently, for small renal masses, the risk of ensuing chronic kidney disease and end stage renal disease has largely favored nephron-sparing surgical techniques, mainly partial nephrectomy. In this review, we surveyed the literature on renal functional outcomes after partial nephrectomy for renal tumors. The largest randomized control trial comparing radical and partial nephrectomy failed to show a survival benefit for partial nephrectomy. With regards to overall survival, surgically induced chronic kidney disease (GFR < 60 ml/min/ 1.73m2) caused by nephrectomy might not be as deleterious as medically induced chronic kidney disease. In evaluating patients who underwent donor nephrectomy, transplant literature further validates that surgically induced reductions in GFR may not affect patient survival, unlike medically induced GFR declines.  Yet, because patients who present with a renal mass tend to be elderly with multiple comorbidities, many develop a mixed picture of medically, and surgically-induced renal disease after extirpative renal surgery.  In this population, we believe that nephron sparing surgery optimizes oncological control while protecting renal function. 

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