Dion Marie, Martínez Carlos H, Williams Andrew K, Chalasani Venu, Nott Linda, Pautler Stephen E
Division of Urology, Department of Surgery and Division of Surgical Oncology, Department of Oncology, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON, Canada;
Can Urol Assoc J. 2010 Oct;4(5):322-6. doi: 10.5489/cuaj.10017.
The cost of surveillance strategies in patients after radical nephrectomy for localized primary renal cell carcinoma (RCC) has not been evaluated. We compared the costs of 2 different surveillance strategies, the new Canadian Urological Association (CUA) guidelines and the old strategy implemented in our institution.
Seventy-five patients who underwent radical nephrectomy for primary non-metastatic renal cancer were retrospectively reviewed. The direct cost of surveillance was determined and compared with the theoretical cost which would have been accrued using the CUA guidelines.
Our mean follow-up was 31.1 (SD ± 20.4) months. The overall and disease-free survival endpoints were 87.7% and 85.2%, respectively. Total medical costs were higher for our old institutional surveillance strategy than the CUA guidelines ($181 861 vs. $135 054). For the complete follow-up of 75 patients, a cost-savings of $46 806 could have been achieved following the CUA guidelines (p = 0.002). Of recurrences, 7 of 8 were detected by routine screening, only 1 recurrence was identified by symptoms. The cost per recurrence detected in our old protocol was $9 812.92. The increased cost of our institution was due to more visits with basic testing, symptomatic investigation, and follow-up of imaging tests. The median percent cost attributable to these extra tests was 15% (range 0 to 59).
Based on our results, we endorse the new CUA surveillance strategy in RCC follow-up as appropriate and cost effective in comparison with previous follow-up strategies used at our institution.
对于局限性原发性肾细胞癌（RCC）患者，根治性肾切除术后监测策略的成本尚未得到评估。我们比较了两种不同监测策略的成本，即新的加拿大泌尿外科协会（CUA）指南和我们机构实施的旧策略。
对75例接受原发性非转移性肾癌根治性肾切除术的患者进行回顾性分析。确定监测的直接成本，并与按照CUA指南本应产生的理论成本进行比较。
我们的平均随访时间为31.1（标准差±20.4）个月。总生存率和无病生存率终点分别为87.7%和85.2%。我们机构旧的监测策略的总医疗成本高于CUA指南（181,861美元对135,054美元）。对于75例患者的完整随访，遵循CUA指南本可节省46,806美元的成本（p = 0.002）。在复发患者中，8例中有7例是通过常规筛查发现的，只有1例复发是通过症状发现的。我们旧方案中检测到的每次复发的成本为9,812.92美元。我们机构成本增加的原因是更多的基础检查、症状性检查以及影像检查随访。这些额外检查导致的成本中位数百分比为15%（范围0至59）。
基于我们的结果，我们认可在RCC随访中采用新的CUA监测策略，与我们机构之前使用的随访策略相比，该策略既合适又具有成本效益。
