Percutaneous cryoablation yields outcomes comparable to robotic surgery for renal cancer, at significantly lower cost and with a clear net monetary benefit, according to prospective real-world data from Denmark.

Five-year survival for renal cell carcinoma (RCC) ranges from 97% for stage 1 to 27% for stage 4 disease. Effectively controlling stage 1 tumours, which account for about two-thirds of all new cases, is a critical priority, with robot-assisted partial nephrectomy (RAPN) serving as the standard of care.

The recent study, published in the journal CardioVascular and Interventional Radiology, assessed the comparative cost-effectiveness of computed tomography-guided percutaneous cryoablation versus RAPN for cT1N0M0 RCC using real-world outcomes and a five-year health economic model.

Prospective real-world outcomes data were drawn from two Danish university hospitals between June 2019 and February 2021. Patients came from the NEPHSPARE cohort.

Of the 171 eligible cT1 patients, 80 underwent RAPN and 91 underwent percutaneous cryoablation. This second group were older, had more comorbidities, had lower baseline renal function and generally had smaller tumours and higher case complexity than the RAPN patients.

Inverse probability of treatment weighting was used to generate matched pseudo-populations for outcome modelling.

Health economics assessment of PCA and RAPN

A Markov model estimated quality-adjusted life years (QALYs) and direct medical costs from the Danish healthcare perspective, with both discounted at 3% over a five-year time period.

QALYs were nearly identical (3.323 PCA vs 3.315 RAPN). However, cost differences were material and directional: percutaneous cryoablation was associated with a 32% lower total cost over five years compared to RAPN (€18,795 vs €27,520).

At a willingness-to-pay threshold of €40,000/QALY, percutaneous cryoablation delivered a positive net monetary benefit of €9,045. Deterministic sensitivity demonstrated that percutaneous cryoablation remained cost-effective across all tested ranges, driven primarily by its cost structure and metastasis rate sensitivity.

Equivalent cancer care at lower cost

The researchers concluded that percutaneous cryoablation proved economically superior to RAPN, delivering equivalent RCC control at a lower cost.

There were no significant differences in local recurrence, metastatic progression or severe complications (Clavien-Dindo classification ≥ III) between the two modalities. Hospital stay was shorter with percutaneous cryoablation, with 85 of 91 patients treated as day cases, compared with RAPN which had a mean of 1.9 nights.

Some limitations of the analysis were apparent, with the researchers noting that percutaneous cryoablation was undertaken in only one expert centre, whereas RAPN used two. Therefore, centre-linked organisational influences cannot be excluded. They also cautioned that residual unmeasured confounding may still exist despite propensity weighting.

Both T1a and T1b tumours were included, but a subgroup analysis based on T1a alone was not feasible. RAPN used an official national diagnosis-related group tariff, but percutaneous cryoablation had to be bottom-up cost-estimated, leading to a slight risk of distortion in either direction. Infrastructure and ancillary pre-procedural interventions were also not costed.

Nevertheless, the results of the analysis support percutaneous cryoablation as a cost-effective first-line modality in T1 disease, not limited to frailty or T1a guideline-restricted indications, when performed in experienced centres with established capability.

Reference
Junker T et al. Comparison of health economics in robot-assisted partial nephrectomy and CT-guided cryoablation for the management of T1 renal cell carcinoma: an analysis of a prospective Danish cohort. Cardiovasc Intervent Radiol 2025;Oct 15:doi 10.1007/s00270-025-04224-2.