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

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, qualityadjusted 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 60yr-old men resulted in an ICER of £18 092/QALY (s22 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 (s47 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 (s37 878/QALY), the population-expected values of perfect information were £194 million (s244 million) and £97 million (s123 million) for 60-yr-old men and women, respectively. The expected value y Joint senior authors.

Acceptability and potential impact on uptake of using different risk stratification approaches to determine eligibility for screening: A population‐based survey

“…This has led to international interest among the scientific and lay community in developing a potential screening programme for this ‘silent’ cancer 10,11 . As for other screening programmes, the cost‐effectiveness of any programme would be highly dependent on prevalence of kidney cancer in those screened 12 . Targeted screening of higher‐risk individuals using established risk factors is, therefore, like to be the most cost‐effective strategy to maximize the benefits and reduce the harms of screening 13 .…”

Challenges of early renal cancer detection: symptom patterns and incidental diagnosis rate in a multicentre prospective UK cohort of patients presenting with suspected renal cancer

“…2 The potential costeffectiveness of performing a single, renal focused, ultrasound scan among asymptomatic 60-year-old men has recently been reported. 26 However, numerous uncertainties still exist, in terms of who to screen, with what modality, as well as unknowns in terms of associated harms vs benefit. 27 This is an area that clearly warrants further research.…”

Novel Liquid Biomarkers and Innovative Imaging for Kidney Cancer Diagnosis: What Can Be Implemented in Our Practice Today? A Systematic Review of the Literature

“…(1) There is currently no validated imaging-or biomarkerbased screening program [4]; beyond a high number needed to screen, a cancer diagnosis does not infer a life-threatening RCC. (2) The risk of thoracoabdominal computed tomography (CT) imaging is correlated with RCC treatment [5], making surgery a "risk" of excessive cross-sectional imaging.…”

“…(3) Up to one-third of small tumours after nephrectomy are benign [6]. (4) The vast majority of patients with localised renal masses pursue management without knowledge of histology [7]. This contributes to several undesirable effects, including the increased surgical treatment of small renal masses (SRMs) driven by the diffusion of robotic surgery [8] and the limited utilisation of active surveillance [7].…”