AUA 2019: Cost Benefit Analysis Favors Sonograpic Screening for Renal Tumors
As a result, the rate of patients presenting with de novo metastatic renal cell carcinoma (RCC) has declined significantly over the past two decades. Dr. Haifler and colleagues hypothesized that organized screening for RCC using ultrasound may be cost-effective. In a podium presentation at the American Urologic Association Annual Meeting, they present the results of a Markov model they developed to assess the cost-effectiveness of screening abdominal ultrasound for renal tumors in the general population over the age of 60 years.
The authors developed a Markov model to examine quality-adjusted life years (QALYs) and financial costs associated with the implementation of screening abdominal ultrasound for renal tumors.
The authors report that adoption of screening abdominal ultrasound for renal tumors would only marginally increase quality adjusted life years, from 21.7385 in a strategy without screening abdominal ultrasound to 21.7396 in a strategy with screening abdominal ultrasound. While this increase in QALY is small (0.001), the cost of the intervention was low ($137.40 USD, as compared to estimated costs of a non-screening strategy of $31 USD, a difference of $86.40 USD). Thus, the resulting incremental cost-effectiveness ratio (ICER) is $27,548.21 USD per QALY. This falls well below standard willingness to pay thresholds of $50,000 or $100,000 per QALY. Thus, on the basis of this analysis, it would appear that screening for RCC using abdominal ultrasound in people over the age of 60 years is cost-effective.
The authors report that the two variables which were most influential on model outputs and conclusions were the prevalence of RCC in the population and the estimated costs.
The authors estimated that abdominal ultrasonography would cost $35.81 per exam. This appears to vastly underestimate the current costs of abdominal ultrasound in the US, where the national average is approximately $390 USD. Thus, while these results are interesting and provocative, it is unclear to what degree they are applicable to the current healthcare landscape.
Presented by: Guy Verhovsky, MD, Department of Urology, Assaf Harofeh Medical Center, Rishon LeẔiyyon, Israel
Co-authors: Miki Haifler, Yishai Hode Rappaport, Michael Leshno, Amnon Zisman, Shmuel Roizman
Written by: Christopher J.D. Wallis, Urology Resident, University of Toronto, @WallisCJD on Twitter at the American Urological Association's 2019 Annual Meeting (AUA 2019), May 3 – 6, 2019 in Chicago, Illinois