Login to Access Video or Poster Abstract: MP100-10
Sources of Funding: none

Introduction

The evolving health care environment is placing increased emphasis on cost effectiveness. We investigate the cost of pre-procedure biopsy of renal masses vs immediate cryoablation with intraoperative biopsy for patients with small renal masses who are candidates for cryotherapy.

Methods

We retrospectively identified all patients who had laparoscopic cryoablation for a renal tumor by a single surgeon at an academic center between 2004 and 2013. Pathology results from intraoperative biopsies were collected. Cost analysis was performed for two treatment algorithms. Algorithms differed in the initial step in management: CT guided biopsy vs laparoscopic cryoablation with intraoperative biopsy. _x000D_

Results

There were 96 patients in the study. Pathology results from intraoperative biopsies were: Cancer: 64 (66.7%), Indeterminate: 12 (12.5%), and Benign: 20 (20.8%). Cost of laparoscopic cryoablation and hospital stay is $10,600. Cost of a CT guided biopsy is $5,400. Cost of 5 years of surveillance is $37,400. On average, the five-year cost to manage a patient initially with laparoscopic cryoablation is $40,200. This compares to $43,400 for CT guided biopsy as first management. In order for CT guided biopsy to be cost effective, 52% of small renal masses deemed appropriate for cryoablation would need to be benign._x000D_

Conclusions

Immediate cryoablation is slightly more cost effective than getting a pre-operative CT guided biopsy for patients considering treatment of small renal masses with laparoscopic cryoablation. The cost difference is not enough to unilaterally drive clinical decisions but shared decision making should include cost. The overwhelming cost over five years is driven by cost of surveillance imaging._x000D_

Funding

none