Partial nephrectomy is recommended over radical nephrectomy for the surgical treatment of patients with stage cT1 renal cancer in multiple guidelines. The objective of this study is to examine the cost effectiveness of robot-assisted partial nephrectomy (RAPN), compared with open radical nephrectomy (ORN) or laparoscopic radical nephrectomy (LRN), for treating stage cT1 renal cancer in Korea.

A Markov model was applied in patients with cT1 renal cancer that consisted of the following six health states: post-surgery, normal, chronic kidney disease (CKD), dialysis, death from renal failure, and natural death. Utilities and transition probabilities were obtained from systematic literature reviews. Costs were obtained from the current Korean National Health Insurance fee schedule, the Korean medical literature, and 2016 Health Insurance Review and Assessment Service inpatient claims data. Univariate and probabilistic sensitivity analyses were performed to check for uncertainty.

RAPN was the dominant treatment, costing KRW 2.1 to 3.6 million (USD 1,700 to 2,900) less than the comparators while providing 0.45 to 0.61 more utility. Univariate sensitivity analysis showed that the most sensitive parameter was the relative risk reduction of CKD after partial nephrectomy. The sensitivity analysis also showed that the acceptability of RAPN at a cost-effectiveness threshold of KRW 30.5 million was high relative to both comparators (85.9% against LRN and 78.9% against ORN).

Though there might be uncertainties in non-Korean utility data and some transition probabilities derived from Japanese data, the current study suggested that partial nephrectomy is a more cost-effective option than ORN or LRN in Korea for patients with stage cT1 renal cancer.