Societal Costs of Localized Renal Cancer Surgery

Abstract

Purpose: Hospital-related costs of renal cancer surgery have been described, but the societal costs of surgery-related lost productivity are poorly understood. We sought to estimate the societal cost of renal cancer surgery by assessing surgery-related time off work (TOW) taken by patients and their caretakers. Methods: 413 subjects who underwent partial or radical nephrectomy enrolled in an IRB-approved prospective quality-of-life study were administered 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 to the survey, 138 were employed at time of surgery. 97 subjects returned to work and met the inclusion criteria, and were analyzed. Mean age was 54. 56% of subjects had sedentary jobs. TOW ranged from 7 to 92 days; mean (SD) and median (IQR) TOW was 35 (17) and 33 (24-44) days, respectively. 58% of subjects took > 30 days off. Mean potential wages lost for TOW was $10,152 (SD=$8,153). 83% 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 patients take over one month off work after renal cancer surgery; those having sedentary jobs tend to return to work sooner. Recognizing these societal costs may allow better adjustment of patient expectations, and more comprehensive cost-effectiveness analyses in renal cancer care.