A Decision Analysis Evaluating Screening for Kidney Cancer Using Focused Renal Ultrasound.

Abstract

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.