Cost aspects of radical nephrectomy for the treatment of renal cell carcinoma in Korea: Open, laparoscopic, robot-assisted laparoscopic, and video-assisted minilaparotomy surgeries

Purpose: 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). Materials and 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.