A Decision Analysis Evaluating Screening for Kidney Cancer Using Focused Renal Ultrasound.
European urology focus
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Rossi, S., Klatte, T., Usher-Smith, J., Fife, K., Welsh, S., Dabestani, S., Bex, A., et al. (2019). A Decision Analysis Evaluating Screening for Kidney Cancer Using Focused Renal Ultrasound.. European urology focus https://doi.org/10.1016/j.euf.2019.09.002
BACKGROUND: Screening for renal cell carcinoma (RCC) has been identified as a key research priority; however, no randomised control trials have been performed. Value of information analysis can determine whether further research on this topic is of value. OBJECTIVE: To determine (1) whether current evidence suggests that screening is potentially cost effective and, if so, (2) in which age/sex groups, (3) identify evidence gaps, and (4) estimate the value of further research to close those gaps. DESIGN, SETTING, AND PARTICIPANTS: A decision model was developed evaluating screening in asymp- tomatic individuals in the UK. A National Health Service perspective was adopted. INTERVENTION: A single focused renal ultrasound scan compared with standard of care (no screening). Outcome measurements and statistical analysis: Expected lifetime costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER), discounted at 3.5% per annum. RESULTS AND LIMITATIONS: Given a prevalence of RCC of 0.34% (0.18–0.54%), screening 60-yr-old men resulted in an ICER of £18 092/QALY (s22 843/QALY). Given a prevalence of RCC of 0.16% (0.08–0.25%), screening 60-yr-old women resulted in an ICER of £37 327/QALY (s47 129/QALY). In the one-way sensitivity analysis, the ICER was <£30 000/QALY as long as the prevalence of RCC was !0.25% for men and !0.2% for women at age 60 yr. Given the willingness to pay a threshold of £30 000/QALY (s37 878/QALY), the population-expected values of perfect information were £194 million (s244 million) and £97 million (s123 million) for 60-yr-old men and women, respectively. The expected value of perfect parameter information suggests that the prevalence of RCC and stage shift associated with screening are key research priorities. CONCLUSIONS: Current evidence suggests that one-off screening of 60-yr-old men is potentially cost effective and that further research into this topic would be of value to society.
TUF, CRUK, KCUK, renal cancer research fund
Urology Foundation (unknown)
Cancer Research UK (21464)
External DOI: https://doi.org/10.1016/j.euf.2019.09.002
This record's URL: https://www.repository.cam.ac.uk/handle/1810/296811
Attribution-NonCommercial-NoDerivatives 4.0 International
Licence URL: https://creativecommons.org/licenses/by-nc-nd/4.0/