Localized Renal Cancer Surgery Associated with Substantial Costs from Lost Productivity

March 2015, Vol 6, No 2

Orlando, FL—The total costs of renal surgery are not limited to hospitalization but accrue long after discharge. According to data presented at the 2015 Genitourinary Cancers Symposium, most patients took more than 30 days off work after radical or partial nephrectomy, with the average estimated wages lost to unpaid time exceeding $10,000.

“Despite advances in minimally invasive surgery,” said the study’s lead investigator, Peter Chang, MD, MPH, Urologic Oncology, Beth Israel Deaconess Medical Center, Boston, MA, “more than 50% of patients take over 1 month off from work after localized renal cancer surgery. The mean estimated wages lost from surgery-related time off work, assuming unpaid leave, was $10,371.”

Hospital-related direct and indirect costs of radical and partial nephrectomy have been previously evaluated, Dr Chang said. However, costs associated with time off work and potential lost wages or caretaker assistance have not been documented after renal cancer surgery.

“Loss of productivity related to time taken off work hasn’t been well-characterized before, so that’s what we wanted to examine in greater detail with this study,” he said.

The initial cohort consisted of 315 men and women with localized renal cancer undergoing radical and partial nephrectomy enrolled in a prospective quality-of-life study at an academic medical center. The patients responded to a questionnaire asking them about time off work, job physicality, income by tax bracket, and need for caretaker assistance.

“We asked the patients…how many people were required to take care of them while they were at home, because that’s additional people who might be required to take off work,” Dr Chang said.

The analytic cohort consisted of 69 patients who were employed at the time of surgery. (Patients who underwent ­cytoreductive nephrectomy or were ­unemployed at the time of surgery were excluded from analysis.)

Dr Chang and his colleagues obtained the outcome of potential lost wages as a result of time off work by multiplying the average income in the reported tax bracket by the time taken off work divided by 365 days. Of the patients, 33% had at least 1 caretaker take time off work during convalescence.

With this study, Dr Chang also sought to identify predictors of taking time off work for more than 30 days.

“The cost of lost productivity and wages is substantial,” Dr Chang affirmed, “and it hasn’t really been quantified before. We believe it should at least be taken into account when considering economic costs of cancer care….Incorporating these societal costs should allow for more comprehensive cost-­effectiveness analysis.”

Future directions include assessing time off work and other societal costs prospectively in a larger, more diverse cohort.

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