Introduction and Objectives: Renal cell carcinoma (RCC) accounts for 2–3% of all cancers. With increasing use of Computer Tomography, a large proportion are detected earlier and amenable to focal therapies such as Radiofrequency Ablation (RFA). Our institution is unable to offer image‐guided percutaneous ablation (PA) through the public service due to lack of Interventional Radiology (IR) resources. Currently, patients with a small renal mass (SRM) are either actively observed, undergo radical nephrectomy (RN), partial nephrectomy (PN) or referred to another tertiary institution for focal therapy. Recent studies have demonstrated no difference in long‐term efficacy between RN, PN and PA treatment of SRMs in selected patients; but with significantly higher rates of morbidity in the surgical treatment groups. Our Urology Multidisciplinary Team (MDT) is supported by an interventional radiologist with Uroradiology specialisation who provides PA for our patients through a private facility and we assessed the cost‐effectiveness of our institution outsourcing PA .

The aim of the study was to compare the costs associated with performing nephrectomies (RN, PN) in a public hospital with the costs of performing minimally invasive PA in a private hospital; and to assess the financial impact on the public system of the different treatment options for SRMs.

Methods: The cost of performing PA at a large tertiary private hospital for patients with a SRM (<4 cm) between October 2017‐October 2018 was calculated and compared to the cost of RN or PN for patients with a SRM between January 2015 to June 2018 at a tertiary public hospital.

Results: Twelve patients underwent PA (radiofrequency ablation or microwave ablation); 10 were performed under conscious sedation. A total of 56 RN and PN were performed during the studied period, including 19 patients with a SRM (RN = 15; PN = 4 with the majority (n = 17) performed laparoscopically. Mean size of lesions was similar (surgery = 29.8 mm; RFA = 27.2 mm). The average procedural time was significantly longer with surgery (219.66 min vs 54.75 min). Length of stay was longer with surgery. Cost per admission for surgery was $19 302.66 which was higher than PA costs of $4513 at a private institution. The cost of performing equivalent PA in a public hospital was calculated to be $2784.35, however this would not include staffing costs (doctors, nurses, radiographers etc).Outsourcing of PA was associated with additional Urology and Radiology appointments, MDT meetings, travel for patients and logistical challenges for the treating teams.

Conclusion: The cost of outsourcing focal treatment of SRMs with PA to a private hospital appears to be similar to the same service provided in a public hospital. PA is more cost‐effective than surgery in carefully selected patients. The additional benefits of providing PA in a public hospital would include more streamlined management and continuity of care for patients. Greater funding for interventional radiology services to provide PA procedures in public hospitals should be considered by health authorities to improve access to less‐invasive treatments for SRMs and result in considerable cost‐savings for health budgets.