Cost-Effectiveness Analysis of the Clear Cell Likelihood Score against Renal Mass Biopsy for Evaluating Small Renal Masses

Abstract

Objective: To examine the cost-effectiveness of the clear cell likelihood score compared to renal mass biopsy alone.

Methods: The clear cell likelihood score, a new grading system based on multiparametric magnetic resonance imaging, has been proposed as a possible alternative to percutaneous renal mass biopsy for identifying clear cell renal carcinoma in small renal masses and expediting treatment of high-risk patients. A decision analysis model was developed to compare a renal mass biopsy strategy where all patients undergo biopsy and a clear cell likelihood score strategy where only patients that received an indeterminant score of 3 undergo biopsy. Effectiveness was assigned 1 for correct diagnoses and 0 for incorrect or indeterminant diagnoses. Costs were obtained from institutional fees and Medicare reimbursement rates. Probabilities were derived from literature estimates from radiologists trained in the clear cell likelihood score.

Results: In the base case model, the clear cell likelihood score was both more effective (0.77 vs. 0.70) and less expensive than renal mass biopsy ($1629 vs. $1966). Sensitivity analysis found that the nondiagnostic rate of renal mass biopsy and the sensitivity of the clear cell likelihood score had the greatest impact on the model. In threshold analyses, the clear cell likelihood score was the preferred strategy when its sensitivity was greater than 62.7% and when an MRI cost less than $5332.

Conclusions: The clear cell likelihood score is a more cost-effective option than renal mass biopsy alone for evaluating small renal masses for clear cell renal carcinoma.