NEW ORLEANS, LA USA (UroToday.com) - Small solid renal masses (SRM) that incidentally diagnosed during abdominal imaging are increasing nowadays. Since ~25% of these SRMs are benign and modern SRM biopsy techniques have become more accurate, the overtreatment of SRMs may not be cost-effective. The authors studied the cost-effectiveness of percutaneous biopsy as the initial step in SRM treatment using a Markov modeling approach.
They used a special model called a Markov model which was developed by The TreeAge Pro Healthcare Suite® (Williamstown, MA) to assess the cost effectiveness of renal biopsy as the initial step in managing a T1a SRM in a 65-year-old man. Eight health states and nine treatment options (including open and robotic partial nephrectomy, radical nephrectomy, cryoablation, and active surveillance) were modeled. Treatment success, complication rates, costs, and survival rates were derived from the published literature. Such a study may be helpful in detecting tumors that could be effectively treated with reasonable costs.
The Markov model demonstrated that SRM biopsy prior to surgery was always more cost effective than empiric SRM treatment, regardless of surgical approach. Specifically, 3 of the 9 treatment options were most cost-effective: active surveillance (AS), biopsy before cryoablation (biopsy +/- cryo), and biopsy before robotic partial nephrectomy (biopsy +/- RPN). While active surveillance was the most economical option, it was the least effective in terms of quality-adjusted life years (QALYs). Biopsy +/- RPN was the most effective strategy overall, generating 12.71 QALYs at a total cost of $34,380, for an incremental cost effectiveness ratio (ICER) of $18,760/QALY compared to biopsy +/- cryo. _x000D_ _x000D_ sensitivity analyses showed that biopsy +/- RPN was the optimal strategy over a wide range of parameters, even when biopsy sensitivity and specificity were set at 0.5. At a societal willingness-to-pay threshold of $50,000/QALY, biopsy +/- RPN remained the most cost-effective strategy for men aged 55-75. Biopsy +/- cryo was the optimal strategy beginning at age 76, and remained cost-effective through age 90, when AS became dominant.
They concluded that in a 55-75 year old man with a T1a SRM, pre-operative biopsy is always more cost effective than empiric treatment, regardless of surgical approach. Specifically, SRM biopsy prior to robotic partial nephrectomy is most cost-effective, superseding open partial, cryo, radical nephrectomy and AS. As patients age past 75, biopsy +/- cryo becomes more cost effective, and beyond that, AS becomes most cost effective.
Presented by Michael Rydberg at the American Urological Association (AUA) Annual Meeting - May 15 - 19, 2015 - New Orleans, LA USA
Chicago, IL USA
Reported by Bilal Farhan, MD (University of California-Irvine), medical writer for UroToday.com