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

Accepted version
Peer-reviewed

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Type

Article

Change log

Authors

Rossi, Sabrina H 
Klatte, Tobias 
Usher-Smith, Juliet A 
Fife, Kate 
Welsh, Sarah J 

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 asymptomatic 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 (€22 843/QALY). Given a prevalence of RCC of 0.16% (0.08-0.25%), screening 60-yr-old women resulted in an ICER of £37327/QALY (€47 129/QALY). In the one-way sensitivity analysis, the ICER was <£30000/QALY as long as the prevalence of RCC was ≥0.25% for men and ≥0.2% for women at age 60yr. Given the willingness to pay a threshold of £30000/QALY (€37 878/QALY), the population-expected values of perfect information were £194 million (€244 million) and £97 million (€123 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. PATIENT SUMMARY: Economic modelling suggests that screening 60-yr-old men for kidney cancer using ultrasound may be a good use of resources and that further research on this topic should be performed.

Description

Keywords

Cost-effectiveness, Kidney cancer, Renal cell cancer, Screening, Ultrasound, Carcinoma, Renal Cell, Cost-Benefit Analysis, Decision Support Techniques, Early Detection of Cancer, Female, Humans, Kidney Neoplasms, Male, Mass Screening, Middle Aged, State Medicine, Ultrasonography

Journal Title

Eur Urol Focus

Conference Name

Journal ISSN

2405-4569
2405-4569

Volume Title

7

Publisher

Elsevier BV
Sponsorship
Urology Foundation (unknown)
Cancer Research UK (21464)
MRC (MR/T024097/1)
TUF, CRUK, KCUK, renal cancer research fund