Laparoscopic and open partial nephrectomy: cost comparison with analysis of individual parameters

Abstract

Introduction: Laparoscopic partial nephrectomy (LPN) is less morbid than open partial nephrectomy (OPN), but the high cost of new technologies used in LPN may make this a significantly more expensive procedure. In this study, the overall costs of OPN and LPN were compared using data extracted from the literature, and a series of sensitivity analyses were performed to determine the impact of individual cost components on overall cost.

Materials and methods: Data on operating room (OR) time, equipment use, and length of stay (LOS) were abstracted after a comprehensive literature review of LPN and OPN. Decision tree models were devised to estimate the cost of each treatment using the DATA program (TreeAge software 3.5). LPN model assumptions included one that used all reusable equipment, all disposable equipment, and a hand-assist model. One and two-way sensitivity analyses were performed to evaluate the effect of individual treatment variables on overall cost.

Results: The literature yielded 12 OPN and 13 LPN articles, comprising a total of 574 and 949 patients, respectively. The weighted mean LOS were 5.7 and 2.9 days (<0.001); average tumor sizes were 3.2 cm and 2.5 cm (P = 0.016); and the weighted mean OR times were 184 and 187 minutes for OPN and LPN (P = 0.7), respectively. The LPN model using all disposable equipment is less costly than OPN by $431 ($8450 v $8019). The slight cost superiority of the laparoscopic approach was driven by shorter LOS. One-way sensitivity analyses showed that LPN is less costly if the OR time of LPN is less than 146 minutes; LOS after LPN is less than 4.6 days; or LPN OR supply costs are less than $1670. Two-way sensitivity analyses demonstrated the effects of modifying OR time, LOS, and surgical equipment on the cost-equivalence of LPN and OPN.

Conclusions: Laparoscopic partial nephrectomy can be cost equivalent to the open approach in managing small renal masses if the OR time, LOS, and equipment costs are closely monitored. The high cost of new technologies can be offset by shorter LOS and decrease in OR time.