1 COST ANALYSIS OF NEPHRON-SPARING SURGERY FOR RENAL MASSES

Vol. 183, No. 4, Supplement, Saturday, May 29, 2010

THE JOURNAL OF UROLOGY姞

General & Epidemiological Trends & Socioeconomics: Evidence-based Medicine & Outcomes I Moderated Poster 1 Saturday, May 29, 2010

1:00 PM-3:00 PM

1 COST ANALYSIS OF NEPHRON-SPARING SURGERY FOR RENAL MASSES Raymond Leveillee*, Vincent Bird, Rajan Ramanathan, Mohammed Aziz, John Shields, Caulton Darryl, Ahmed Eldefawry, Miami, FL INTRODUCTION AND OBJECTIVES: Cost of health care is an important factor when discussing optimization of health care delivery without hindering outcome, including oncological outcome, and patient quality of life. Our aim is to compare the in-patient cost of patients undergoing nephron-sparing surgeries for renal masses at our institution. We compared computerized tomography-guided radiofrequency ablation (CT- RFA), laparoscopic-guided radiofrequency ablation (LRFA), laparoscopic partial nephrectomy (LPN), open partial nephrectomy (OPN), and robotic-assisted laparoscopic partial nephrectomy (RA-LPN) as treatments for a renal mass. METHODS: From our prospective database we identified the last ten patients undergoing the included procedures: CT-RFA, L-RFA, LPN, OPN, RA-LPN. All procedures took place over a seven year time frame (2002-2009). Patients were matched for tumor size (T1a). Procedures took place in one institution. Data collected for patient parameters included age, co-morbidities, tumor stage, and pathology, as well as cost of laboratory investigations, imaging studies, room and board, operating rooms, disposable equipment, pharmacy, anesthesia service, post-anesthesia care, and transfusion (in-hospital cost). Professional fees for the urologist, anesthesiologist, radiologist, and pathologist were calculated based on Medicare values for uniformity. Total cost for technical approach (including in-patient cost and professional fees) was calculated. Operative time was recorded from patient entry to patient exit from the operating room. RESULTS: Table 1 shows the results comparing all five groups. All patients had pathologically confirmed renal cell carcinoma. The operative costs of the five approaches varied according to the different in-patient, professional, and total costs (Figure 1). RA-LPN proved to be associated with the highest total cost ($15,444), followed by LPN (14,380). OPN was intermediate in cost ($10,000). CT-RFA was the most economic approach ($5,643) followed by LRFA ($8,828). CT-RFA also had the lowest in-patient cost. CONCLUSIONS: The total medical cost of managing small renal tumors is variable depending on the method of treatment. CTRFA proved to be the most economic approach followed by LRFA. These procedures were not only noted not only to be the most economical, but also to have the lowest associated in-patient cost. TABLE 1. COST ANALYSIS FOR DIFFERENT TREATMENT MODALITIES FOR RENAL MASS RA-LPN LPN OPN CT RFA LAP RFA Operating room time (mins) 390 318 335 180 180 LOS (days)

2.75

3

3.5

0.5

1.1

In-Hospital

$12,579

$11,685

$7,456

$3,401

$6,910

Urologist fee

$1,718

$1,718

$1,518

$1,445

$1,344

Anesthiologist fee

$920

$750

$799

$460

$460

Pathologist fee

$227

$227

$227

$114

$114

Radiologist fee

N/A

N/A

N/A

$223

N/A

Total Cost

$15,444

$14,380

$10,000

$5,543

$8,828

Cost

Source of Funding: None

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2 ECONOMIC BURDEN OF NOCTURIA IN THE US ADULT POPULATION Tove Holm-Larsen, Copenhagen, Denmark; Jeffrey P Weiss*, Brooklyn, NY; Lars K Langkilde, Vejle, Denmark INTRODUCTION AND OBJECTIVES: Nocturia is a common condition which can have a profound negative effect on quality of life, mainly due to its impact on sleep. Poor sleep leads to a series of problems for health, functioning and productivity, all well documented in the sleep research literature. However, the economic burden on society of the effects of nocturia is not well understood. This study provides an estimate of the economic burden relating to work productivity and falls in the US population with nocturia. METHODS: Using the Boston Area Community Health (BACH) Study (Fitzgerald et al, 2007), the age and gender-adjusted prevalence of nocturia (ⱖ2 voids/night) in the US was estimated. US data on working hours and salary were obtained from the Bureau of Labor Statistics. The impact of nocturia on work productivity was calculated using published data from a population survey of both absenteeism and productivity in professionally active adults with nocturia vs controls. Subjects reporting nocturia had greater impairment in productivity as measured by the Work Productivity and Activity Impairment questionnaire (13.8% vs 4.61%; 0%⫽maximum productivity, 100%⫽total loss of work productivity; Kobelt et al, 2003). Although this net impairment of 9.19% was based on subjects with ⱖ1 void/night, we used it for people with ⱖ2 voids/night to secure a conservative estimate. To study the impact of nocturia on falls we estimated the proportional population risk from a fall study in elderly nocturia patients (Stewart, 1992). This was applied to the estimated direct medical cost of falls (Carroll et al, 2005) to establish the share of the total cost attributable to nocturia. RESULTS: Based on the BACH study, 28 million people ⱖ30 years in the US regularly suffer from ⱖ2 voids/night. Adjusted for age and gender, a conservative estimate suggests that productivity loss is equivalent to 127 hours per individual per year. With an average US wage of $17.38/h (conservatively based on small-size, private industry salaries), the economic value of the productivity lost in 2008 was $61 billion. In the elderly (ⱖ65 years), the proportional population attributable risk of falling due to nocturia (ⱖ2 voids/night) is 16.2%. The estimated medical cost of associated falls in 2008 was $1.5 billion. CONCLUSIONS: These findings demonstrate that nocturia in professionally active people represents a very significant economical burden for society due to a decrease in productivity. The societal cost of nocturia in the elderly (ⱖ65 years) is also high, but comparably lower because it only relates to an increased risk of falls in this study. Source of Funding: Ferring Pharmaceuticals

3 MORTALITY IN THE ELDERLY CORRELATES WITH THE FREQUENCY OF NIGHTTIME VOIDING: RESULTS OF A 5-YEAR PROSPECTIVE COHORT STUDY IN JAPAN Haruo Nakagawa*, Sendai, Japan; Kaijun Niu, Aendai, Japan; Yasuhiro Kaiho, Yoshihiro Ikeda, Yoichi Arai, Sendai, Japan INTRODUCTION AND OBJECTIVES: Nocturia is a common problem that increases with age. It is often the result of an overproduction of urine at night (nocturnal polyuria), but may also be associated with several pathophysiological conditions, such as cardiovascular disease, diabetes mellitus, sleep apnea syndrome, renal dysfunction, lower urinary tract dysfunction and sleep disorders. An increased mortality rate has been reported with nocturia, and may be related to these associated conditions, or independently to nocturia. This study aimed to evaluate the association between night time frequency and mortality in a community-based elderly population. METHODS: We conducted a Comprehensive Geriatric Assessment of all residents aged ⱖ70 years in 2003 in an urban district of north Japan. The population-based cross-sectional survey was conducted using an extensive health interview for each participant. Mor-