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

Rossi, Sabrina, Klatte, Tobias, Usher-Smith, Juliet A., Fife, Kate, Welsh, Sarah J., Dabestani, Saeed, Bex, Axel, Nicol, David, Nathan, Paul, Stewart, Grant D. and Wilson, Ed (2019) A Decision Analysis Evaluating Screening for Kidney Cancer Using Focused Renal Ultrasound. European Urology Focus. ISSN 2405-4569

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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. Objectives: To determine (a) whether current evidence suggests screening is potentially cost-effective. If so, (b) in which age/sex groups, (c) identify evidence gaps and (d) estimate the value of further research to close those gaps. Design, Setting, 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 measures: Expected lifetime costs, quality adjusted life years (QALYs) and incremental cost-effectiveness ratio (ICER), discounted at 3.5%/annum. Results: Given a prevalence of RCC of 0.34% (0.18-0.54%), screening 60 year-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-year-old women resulted in an ICER of £37,327/QALY[€47,129/QALY]. In the one-way sensitivity analysis, the ICER was <£30,000/QALY so long as the prevalence of RCC was 0.25% for men and 0.2% for women at age 60 years. Given a willingness to pay threshold of £30,000/QALY[€37,878/QALY], the population expected value of perfect information was £194 million[€244 million] and £97 million[€123 million] for 60-year-old men and women respectively. The expected value of perfect parameter information suggests the prevalence of RCC and stage shift associated with screening are key research priorities. Conclusion: Current evidence suggests one-off screening of 60-year 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-year-old men for kidney cancer using ultrasound may be a good use of resources and that further research on this topic should be performed.

Item Type: Article
Additional Information: Copyright © 2019 European Association of Urology. Published by Elsevier B.V. All rights reserved.
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
Depositing User: LivePure Connector
Date Deposited: 13 Sep 2019 00:40
Last Modified: 06 May 2020 00:01
URI: https://ueaeprints.uea.ac.uk/id/eprint/72178
DOI: 10.1016/j.euf.2019.09.002

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