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Minerva Urologica e Nefrologica 2020 Feb 19

DOI: 10.23736/S0393-2249.20.03625-5


lingua: Inglese

Percutaneous cryoablation vs SoC in small kidney cancers: the Italian experience

Antonio CELIA 1, Claudio PUSCEDDU 2, Tommaso SILVESTRI 1, Giovanni B. GIDARO 3, Fabrizio IANNELLO 4 , Elena P. LANATI 4, Anna D'AUSILIO 4

1 S.C. di Urologia, Ospedale San Bassiano, Bassano del Grappa, Vicenza, Italy; 2 Department of Oncological and Interventional Radiology, Oncological Hospital A. Businco, AO Brotzu, Cagliari, Italy; 3 HTA Consultant at BTG, Milan, Italy; 4 MA Provider, Milan, Italy


BACKGROUND: The objective of the present work was to analyse the economic impact of PCA (per- cutaneous cryoablation) vs OPN (open partial nephrectomy), as it represents the most common standard of care for SRMs (Small Renal Masses), namely T1a renal cancers (<4 cm), in Italy.
METHODS: A cost analysis was performed to compare the difference of the total perioperative costs between PCA and OPN, both from the perspective of the National Healthcare System and the hospital. Clinical and resources consumption inputs were retrieved by a non-systematic literature search on scientific databases, complemented by a grey literature research, and validated by expert opinion. Costs calculation for the NHS perspective were based on reference tariffs published by the National Ministry of Health, while for the hospital perspective, unit costs published in the grey literature were used to compare the two alternatives.
RESULTS: Assuming the NHS perspective, the cost analysis shows there is an economic advantage in using PCA vs OPN (€4,080 vs €7,541) for the treatment of SRMs. Hospitalization time is the driver of the total costs, while the costs of complications are quite negligible in both groups. From the hospital perspective the costs of PCA is slightly higher (+€737) than OPN, with cryoprobes contributing as the greatest cost component. However, this increase is quite restrained and is offset by an inferior use of healthcare resources (surgery room, healthcare personnel, length of stay in the hospital).
CONCLUSIONS: According to our analysis, PCA results in an advantageous technique compared to OPN respectively in terms of costs and resource consumption from both the NHS and the hospital perspective.

KEY WORDS: SMRs (Small Renal Masses); OPN (Open Partial Nephrectomy); PCA (Percuneaous cryoablation)

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