San Diego, CA USA (UroToday.com) Kidney cancer is a common malignancy with approximately 61,000 new diagnosis in 2015. Small Renal Mass (SRM) is are renal masses that are < 4cm in diameter, and approximately 20-30% of SRM will be benign pathology. The healthcare cost of SRM remains unknown, as a result of lack of concordance and consensus on the optimal management paradigm.
Active Surveillance (AS) is an attractive option for SRMs, but the cost of repeated imaging should be compared to the cost of upfront delivery treatment. This study by Dr. Shah and team sought to compare the costs associated with active surveillance strategies to that of percutaneous or surgical intervention to identify the highest value management approach.
To carry out the study, costs were calculated as reimbursement for various imaging modalities, and surgical procedures were based on publicly available data from the Centers for Medicare & Medicaid Services (CMS). In the active surveillance arms, a single imaging modality was chosen for the duration of the follow-up period, performed every 6 months in year 1, then yearly to year 5. In the immediate surgical intervention arms, follow-up imaging was modeled as every 3 months for yeah 1, every 6 months in year 2, and yearly for years 3-5
The major findings of this study were that cumulative 5-year cost of surgical treatment and follow-up ranged from $15,375 for radical nephrectomy with post-up renal ultrasound follow-up imaging to $22,454.92 for laparoscopic partial nephrectomy with post-op MRI follow-up imaging. The cumulative 5-year cost of AS ranged from $2,235.94 with renal US to $6,068.48 with abdominal MRI with and without contrast.
In conclusion, active surveillance is a cost-effective management approach for clinical stage T1 renal mass. Overall, the costs varied widely between, and within, different management arms with most of the variation driven by the choice of imaging modality. Future studies correlating of this data with long-term oncological data for both AS and immediate intervention is necessary to help guide future management decisions.
Presented By: Ravi J. Shah, MD
Written By: Nobel Nguyen, Undergraduate Researcher, Department of Urology, University of California, Irvine at the 2016 AUA Annual Meeting - May 6 - 10, 2016 – San Diego, California, USA