title: Cost Comparisons Between Different Techniques of Percutaneous Renal Biopsy for Small Renal Masses.
abstract: OBJECTIVE
  To compare the costs associated with ultrasound (US)-guided hospital-based (UGHB), CT-guided hospital-based (CTG), and US-guided office-based (UGOB) percutaneous renal biopsy (PRB) for small renal masses (SRMs).
  
  
  METHODS
  We retrospectively analyzed patient demographics, tumor characteristics, R.E.N.A.L. nephrometry scores, and cost data of patients undergoing PRB for SRM at our institution from May 2012 to September 2015. Cost data, including facility costs, professional fees, and pathology, were obtained from the departments of urology, radiology, and pathology.
  
  
  RESULTS
  A total of 78 patients were included in our analysis: 19, 31, and 28 UGHB, CTG, and UGOB, respectively. There was no difference in age, gender distribution, or tumor size among the three groups (p-values 0.131, 0.241, and 0.603, respectively). UGOB tumors had lower R.E.N.A.L. nephrometry scores (p=0.008). There were no differences in nondiagnostic rates between the UGHB, CTG, and UGOB groups [4 (21%), 5 (16%), and 6 (21%)] (p=0.852). There were no differences in final tumor treatment strategies utilized among the UGHB, CTG, and UGOB groups (p=0.447). There were 0, 2 (6%), and 0 complications in the UGHB, CTG, and UGOB biopsy groups. Total facility costs were $3449, $3280, and $1056 for UGHB, CTG, and UGOB PRB, respectively (p<0.0001). There was no difference between the urologist's and radiologist's professional fees (p=0.066). Total costs, including facility costs, pathology fees, and professional fees, were $4598, $4470, and $2129 for UGHB, CTG, and UGOB renal biopsy, respectively (p<0.0001).
  
  
  CONCLUSIONS
  For select patients with less anatomically complex, exophytic, and posteriorly located tumors, UGOB PRB provides equivalent diagnostic and complication rates while being significantly more cost-effective than either UGHB or CTG renal biopsy.
authors.affiliation: 1 Department of Urology, University of California , Irvine, Orange, California.
authors.forename: Rahul
authors.initials: R
authors.lastname: Dutta
authors.affiliation: 1 Department of Urology, University of California , Irvine, Orange, California.
authors.forename: Zhamshid
authors.initials: Z
authors.lastname: Okhunov
authors.affiliation: 1 Department of Urology, University of California , Irvine, Orange, California.
authors.forename: Simone L
authors.initials: SL
authors.lastname: Vernez
authors.affiliation: 1 Department of Urology, University of California , Irvine, Orange, California.
authors.forename: Kamaljot
authors.initials: K
authors.lastname: Kaler
authors.affiliation: 1 Department of Urology, University of California , Irvine, Orange, California.
authors.forename: Anjalie T
authors.initials: AT
authors.lastname: Gulati
authors.affiliation: 1 Department of Urology, University of California , Irvine, Orange, California.
authors.forename: Ramy F
authors.initials: RF
authors.lastname: Youssef
authors.affiliation: 2 Department of Radiology, University of California , Irvine, Orange, California.
authors.forename: Kari
authors.initials: K
authors.lastname: Nelson
authors.affiliation: 3 Department of Urology, University of Texas Southwestern Medical Center , Dallas, Texas.
authors.forename: Yair
authors.initials: Y
authors.lastname: Lotan
authors.affiliation: 1 Department of Urology, University of California , Irvine, Orange, California.
authors.forename: Jaime
authors.initials: J
authors.lastname: Landman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D061705:Image-Guided Biopsy / Q000191:economics* / Q000379:methods; D007668:Kidney / Q000000981:diagnostic imaging / Q000473:pathology*; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D047368:Tumor Burden; D014463:Ultrasonography