A decision analysis evaluating screening for kidney cancer using focused renal ultrasound

Rossi, Sabrina H., Klatte, Tobias, Usher-Smith, Juliet A., Fife, Kate, Welsh, Sarah J., Dabestani, Saeed, Bex, Axel, Nicol, David, Nathan, Paul, Stewart, Grant D. and Wilson, Edward C. F. (2021) A decision analysis evaluating screening for kidney cancer using focused renal ultrasound. European Urology Focus, 7 (2). pp. 407-419. 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. 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 £37 327/QALY (€47 129/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 (€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.

Item Type: Article
Additional Information: Copyright © 2019 European Association of Urology. Published by Elsevier B.V. All rights reserved.
Uncontrolled Keywords: cost-effectiveness,kidney cancer,renal cell cancer,screening,ultrasound,urology ,/dk/atira/pure/subjectarea/asjc/2700/2748
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
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Depositing User: LivePure Connector
Date Deposited: 13 Sep 2019 00:40
Last Modified: 28 Jul 2021 00:31
URI: https://ueaeprints.uea.ac.uk/id/eprint/72178
DOI: 10.1016/j.euf.2019.09.002

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