2008 Annual Meeting Abstracts
What is the Cost of Maintaining a Kidney in Upper Tract Transitional Cell Carcinoma? An Objective Analysis of Cost and Survival
Raymond Pak*, Eric Moskowitz, Costas Lallas, Demetrius Bagley
Thomas Jefferson University Hospital, Philadelphia, PA
Introduction:
Although the standard in upper urinary tract transitional cell carcinoma (UT-TCC) management has been nephroureterectomy for years, advances in endourologic instrumentation have allowed urologists to offer renal preservation. There has not been an objective cost analysis performed to date. Our goal was to examine the direct costs of renal sparing conservative measures versus nephroureterectomy and subsequent chronic kidney disease (CKD) or end-stage renal disease (ESRD)
Methods:
Retrospective review of patients treated with renal sparing techniqus for UT-TCC followed for at least 2 years. Direct costs were based on equipment, anesthesia, surgeon fees, pathology,hospital stay, imaging and laboratory. ESRD and CKD costs were estimated based on medicare reports.
Results:
Over 10 years, 254 patients were treated for UT-TCC. Fifty-seven patients met inclusion criteria. Renal preservation was 81% with cancer-specific survival of 94.7%. Figure I. highlights projected costs over time. Renal preservation in solitary kidney patients can save ,272 compared to dialysis with better survival. This savings would cover the expenses of 5 cadaveric renal transplantations. Based on an average of 5.5 recurrences per patient, over five years it costs ,890 to maintain a kidney.
Conclusions:
Conservative endoscopic management of UT TCC in our experience should be the gold standard treatment for low grade and superficial stage disease. From a cost perspective, renal sparing UT TCC management is effective in reducing CKD and ESRD health care expenses. 
