title: Percutaneous Cryoablation vs Partial Nephrectomy: Cost Comparison of T1a Tumors.
abstract: OBJECTIVE
  To compare cost of percutaneous cryoablation vs open and robot-assisted partial nephrectomy of T1a renal masses from the hospital perspective.
  
  
  METHODS
  We retrospectively compared cost, clinical and tumor data of 37 percutaneous cryoablations to 26 open and 102 robot-assisted partial nephrectomies. Total cost was the sum of direct and indirect cost of procedural and periprocedural variables. Clinical data included demographics, Charlson Comorbidity Index (CCI), hospitalization time, complication rate, ICU admission rate, and 30-day readmission rates. Tumor data included size, RENAL nephrometry score, and malignancy rate. Student's t-test was used for continuous variables and Fisher's exact or chi-square tests for categorical data.
  
  
  RESULTS
  Mean total cost was lower for percutaneous cryoablation than open or robot-assisted partial nephrectomy: $6067 vs $11392 or $11830 (p<0.0001) with lower cost of procedure room: $1516 vs $3272 or $3254 (p<0.0001), room and board: $95 vs $1907 or $1106 (p<0.0001), anesthesia: $684 vs $1223 or $1468 (p<0.0001), and laboratory/pathology fees: $205 vs $804 or $720 (p<0.0001). Supply and device cost was higher than open: $2596 vs $1352 (p<0.0001), but lower than robot-assisted partial nephrectomy: $3207 (p=0.002). Mean hospitalization times were lower for percutaneous cryoablation (p<0.0001), while age and CCI were higher (p<0.0001). No differences in tumor size, nephrometry score, malignancy rate complication, ICU, or 30-day readmission rates were observed.
  
  
  CONCLUSIONS
  Percutaneous cryoablation can be performed at significantly lower cost than open and robotic partial nephrectomies for similar masses.
authors.affiliation: 1 Department of Radiology, Oakland University William Beaumont School of Medicine , Royal Oak, Michigan.
authors.forename: Monzer
authors.initials: M
authors.lastname: Chehab
authors.affiliation: 1 Department of Radiology, Oakland University William Beaumont School of Medicine , Royal Oak, Michigan.
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Friedlander
authors.affiliation: 1 Department of Radiology, Oakland University William Beaumont School of Medicine , Royal Oak, Michigan.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Handel
authors.affiliation: 1 Department of Radiology, Oakland University William Beaumont School of Medicine , Royal Oak, Michigan.
authors.forename: Stephen
authors.initials: S
authors.lastname: Vartanian
authors.affiliation: 2 Department of Diagnostic and Interventional Radiology, Oakland University William Beaumont School of Medicine , Royal Oak, Michigan.
authors.forename: Anant
authors.initials: A
authors.lastname: Krishnan
authors.affiliation: 2 Department of Diagnostic and Interventional Radiology, Oakland University William Beaumont School of Medicine , Royal Oak, Michigan.
authors.forename: Ching-Yee Oliver
authors.initials: CY
authors.lastname: Wong
authors.affiliation: 3 Department of Urology, Oakland University William Beaumont School of Medicine , Royal Oak, Michigan.
authors.forename: Howard
authors.initials: H
authors.lastname: Korman
authors.affiliation: 3 Department of Urology, Oakland University William Beaumont School of Medicine , Royal Oak, Michigan.
authors.forename: Brian
authors.initials: B
authors.lastname: Seifman
authors.affiliation: 1 Department of Radiology, Oakland University William Beaumont School of Medicine , Royal Oak, Michigan.
authors.forename: Joseph
authors.initials: J
authors.lastname: Ciacci
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery*; D017115:Catheter Ablation / Q000191:economics*; D003452:Cryosurgery / Q000191:economics*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000191:economics*; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000191:economics