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

Sabrina H Rossi; Tobias Klatte; Juliet A Usher-Smith; Kate Fife; Sarah J Welsh; Saeed Dabestani; Axel Bex; David Nicol; Paul Nathan; Grant D Stewart; Edward C F Wilson

doi:10.1016/j.euf.2019.09.002

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

Eur Urol Focus. 2021 Mar;7(2):407-419. doi: 10.1016/j.euf.2019.09.002. Epub 2019 Sep 14.

Authors

Sabrina H Rossi¹, Tobias Klatte², Juliet A Usher-Smith³, Kate Fife⁴, Sarah J Welsh⁵, Saeed Dabestani⁶, Axel Bex⁷, David Nicol⁸, Paul Nathan⁹, Grant D Stewart¹⁰, Edward C F Wilson¹¹

Affiliations

¹ Department of Surgery, University of Cambridge, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK; Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK; Cancer Research UK Cambridge Centre, University of Cambridge, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK.
² Department of Surgery, University of Cambridge, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK; Department of Urology, Royal Bournemouth Hospital, Bournemouth, UK.
³ The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
⁴ Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK; Cancer Research UK Cambridge Centre, University of Cambridge, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK.
⁵ Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK.
⁶ Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Lund, Sweden.
⁷ The Royal Free London NHS Foundation Trust, Specialist Centre for Kidney Cancer, UK; Netherlands Cancer Institute, Division of Surgical Oncology, Department of Urology, Amsterdam, The Netherlands.
⁸ Department of Urology, Royal Marsden Hospital, London, UK; Institute of Cancer Research, London, UK.
⁹ Department of Oncology, Mount Vernon Cancer Centre, Northwood, UK.
¹⁰ Department of Surgery, University of Cambridge, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK; Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK; Cancer Research UK Cambridge Centre, University of Cambridge, Addenbrooke's Hospital, Cambridge Biomedical Campus, Cambridge, UK. Electronic address: gds35@cam.ac.uk.
¹¹ Cambridge Centre for Health Services Research, University of Cambridge Institute of Public Health, Forvie Site, Robinson Way, Cambridge, UK; Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, UK. Electronic address: ed.wilson@uea.ac.uk.

PMID: 31530498
DOI: 10.1016/j.euf.2019.09.002

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.

Keywords: Cost-effectiveness; Kidney cancer; Renal cell cancer; Screening; Ultrasound.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Carcinoma, Renal Cell / diagnostic imaging*
Carcinoma, Renal Cell / epidemiology
Cost-Benefit Analysis
Decision Support Techniques
Early Detection of Cancer / methods*
Female
Humans
Kidney Neoplasms / diagnostic imaging*
Kidney Neoplasms / epidemiology
Male
Mass Screening / methods*
Middle Aged
State Medicine
Ultrasonography / methods*

Abstract

Publication types

MeSH terms

Grants and funding