Open Access

ARTICLE

Societal costs of localized renal cancer surgery

Peter Chang^1,2,*, Peter Renehan^2,*, Kimberly N. Taylor¹, Lauren E. Dewey¹, Kyle C. McAnally¹, Sara Hyde¹, Catrina M. Crociani¹, Arie Carneiro^3,4, Lisa T. Beaule⁵, Andrew A. Wagner^1,2

1 Division of Urology, Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
2 Harvard Medical School, Boston, Massachusetts, USA
3 Hospital Israelita Albert Einstein, São Paulo, Brazil
4 ABC Medical School, São Paulo, Brazil
5 Maine Medical Center, South Portland, Main, USA
* shared lead authorship
Address correspondence to Dr. Peter Chang, Division of Urology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Rabb 440, Boston, MA 02215 USA

Canadian Journal of Urology 2018, 25(4), 9401-9406.

Abstract

Introduction: Hospital-related costs of renal cancer surgery have been described, but the societal costs of surgery-related lost productivity are poorly understood. We estimated the societal cost of renal cancer surgery by assessing surgery-related time off work (TOW) taken by patients and their caretakers.
Materials and methods: A total of 413 subjects who underwent partial or radical nephrectomy enrolled in an IRB-approved prospective study received an occupational survey assessing employment status, work physicality, income, surgery-related TOW, and caretaker assistance. We excluded subjects with incomplete occupational information or metastatic disease. We estimated potential wages lost using individual income and TOW, and used logistic regression to evaluate for factors predictive of TOW > 30 days.
Results: Of the 219 subjects who responded, 138 were employed at the time of surgery. Ninety-seven subjects returned to work, met the inclusion criteria, and were analyzed. Mean age was 54, and 56% of subjects had sedentary jobs. TOW ranged from 7 to 92 days; mean and median TOW was 35 and 33 days, respectively, and 58% of subjects took > 30 days off. Mean potential wages lost for TOW was $10,152. Eighty-three percent of subjects had at least one caretaker take TOW (mean/median caretaker TOW: 11/7 days, respectively) to assist in recovery. Subjects with sedentary jobs were less likely to take > 30 days off (OR 0.30; 95% CI 0.09-0.99).
Conclusions: Most renal cancer surgery patients take over 1 month off work. Recognizing the associated societal costs may allow better adjustment of patient expectations, and more comprehensive cost-effectiveness analyses in renal cancer care.

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