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Radiofrequency Ablation versus Nephron-sparing Surgery for Small Unilateral Renal Cell Carcinoma: Cost-effectiveness Analysis¹

¹ From the Department of Radiology, Institute for Technology Assessment, Massachusetts General Hospital, 101 Merrimac St, 10th Floor, Boston, MA 02114. From the 2006 RSNA Annual Meeting. Received August 13, 2007; revision requested October 30; revision received December 17; final version accepted February 1, 2008. Supported by National Institutes of Health training grant R25 CA 92203 (Program for Cancer Outcomes Research Training). Address correspondence to P.V.P. (e-mail: pari{at}mgh-ita.org).

Purpose: To evaluate the relative cost-effectiveness of percutaneous radiofrequency (RF) ablation versus nephron-sparing surgery (NSS) in patients with small (4-cm) renal cell carcinoma (RCC), given a commonly accepted level of societal willingness to pay.

Materials and Methods: A decision-analytic Markov model was developed to estimate life expectancy and lifetime costs for 65-year-old patients with a small RCC treated with RF ablation or NSS. The model incorporated RCC presence, treatment effectiveness and costs, and short- and long-term outcomes. An incremental cost-effectiveness analysis was performed to identify treatment preference under an assumed $75 000 per quality-adjusted life-year (QALY) societal willingness-to-pay threshold level, within proposed ranges for guiding implementation of new health care interventions. The effect of changes in key parameters on strategy preference was addressed in sensitivity analysis.

Results: By using base-case assumptions, NSS yielded a minimally greater average quality-adjusted life expectancy than did RF ablation (2.5 days) but was more expensive. NSS had an incremental cost-effectiveness ratio of $1 152 529 per QALY relative to RF ablation, greatly exceeding $75 000 per QALY. Therefore, RF ablation was considered preferred and remained so if the annual probability of post–RF ablation local recurrence was up to 48% higher relative to that post-NSS. NSS preference required an estimated NSS cost reduction of $7500 or RF ablation cost increase of $6229. Results were robust to changes in most model parameters, but treatment preference was dependent on the relative probabilities of local recurrence after RF ablation and NSS, the short-term costs of both, and quality of life after NSS.

Conclusion: RF ablation was preferred over NSS for small RCC treatment at a societal willingness-to-pay threshold level of $75 000 per QALY. This result was robust to changes in most model parameters, but somewhat dependent on the relative probabilities of post–RF ablation and post-NSS local recurrence, NSS and RF ablation short-term costs, and post-NSS quality of life, factors which merit further primary investigation.

© RSNA, 2008