title: Cost aspects of radical nephrectomy for the treatment of renal cell carcinoma in Korea: open, laparoscopic, robot-assisted laparoscopic, and video-assisted minilaparotomy surgeries.
abstract: OBJECTIVE
  This study aimed to comparatively evaluate the cost-effectiveness of four different types of radical nephrectomy (RN) techniques: open, laparoscopic, robot-assisted laparoscopic, and video-assisted minilaparotomy surgery (VAMS).
  
  
  METHODS
  Among patients who were diagnosed with renal cell carcinoma and underwent RN, 20 patients were selected who received open, laparoscopic, robot-assisted laparoscopic, or VAMS RN between January 2008 and December 2010. Their medical fees were divided into four categories: procedure and operation, anesthesia, laboratory test, and medical supply fees. The medical costs of the patients were also divided into insured and uninsured costs.
  
  
  RESULTS
  The total direct cost of VAMS, open, laparoscopic, and robot-assisted laparoscopic RN were 2,023,791±240,757, 2,024,246±674,859 (p=0.998), 3,603,557±870,333 (p<0.01), and 8,021,902±330,157 (p<0.01) Korean Won (KRW, the currency of South Koea), respectively. The total insured cost of VAMS, open, laparoscopic, and robot-assisted laparoscopic RN was 1,904,627±231,957, 1,798,127±645,602 (p=0.634), 3,039,769±711,792 (p<0.01), and 899,668±323,508 (p<0.01) KRW, respectively. The total uninsured cost of VAMS, open, laparoscopic, and robot-assisted laparoscopic RN was 119,163±24,581, 226,119±215,009, 563,788±487,798 (p<0.01), and 7,122,234±56,117 (p<0.01) KRW, respectively. Medical supply fees accounted for the largest portion of the costs and amounted to 33.43% of the VAMS cost.
  
  
  CONCLUSIONS
  VAMS RN is as cost-effective as open surgery. Furthermore, it is comparatively more cost-effective than laparoscopic and robot-assisted laparoscopic RN.
authors.affiliation: Department of Urology, Urological Science Institute, Yonsei University Health System, Seoul, Korea.
authors.forename: Jae Won
authors.initials: JW
authors.lastname: Park
authors.forename: Kyung Hwa
authors.initials: KH
authors.lastname: Choi
authors.forename: Seung Choul
authors.initials: SC
authors.lastname: Yang
authors.forename: Woong Kyu
authors.initials: WK
authors.lastname: Han