MP39-16 COST-EFFECTIVENESS ANALYSIS OF UNIVERSAL CT STAGING VERSUS SELECTIVE CT STAGING STRATEGIES FOR PATIENTS WITH cT1a RENAL MASSES

Abstract

You have accessJournal of UrologyCME1 Apr 2023MP39-16 COST-EFFECTIVENESS ANALYSIS OF UNIVERSAL CT STAGING VERSUS SELECTIVE CT STAGING STRATEGIES FOR PATIENTS WITH cT1a RENAL MASSES Diana Magee, Kevin Ginsburg, Jared Schober, Laura Bukavina, Spencer Bell, Elizabeth Handorf, Alexander Kutikov, Robert Uzzo, and Andres Correa Diana MageeDiana Magee More articles by this author , Kevin GinsburgKevin Ginsburg More articles by this author , Jared SchoberJared Schober More articles by this author , Laura BukavinaLaura Bukavina More articles by this author , Spencer BellSpencer Bell More articles by this author , Elizabeth HandorfElizabeth Handorf More articles by this author , Alexander KutikovAlexander Kutikov More articles by this author , Robert UzzoRobert Uzzo More articles by this author , and Andres CorreaAndres Correa More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003277.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The incidence of metastasis in patients with cT1a masses is an exceedingly rare event. However, guidelines recommend some form of thoracic imaging for patients with newly diagnosed renal masses. Screening for thoracic metastasis can be accomplished with either a chest x-ray (CXR) or CT of the thorax (CTT) and guidelines are agnostic to type of imaging modality utilized. Therefore, we designed a study evaluating the cost-effectiveness of CXR followed by selective CTT compared with that of universal CTT staging. METHODS: Using TreeAgePro 2019 software, we developed a clinical decision tree to estimate the thoracic metastasis detection rate and cost of a selective CTT strategy compared to universal CTT at the time of initial staging in patients with cT1a renal masses. Patients who had a positive CXR subsequently had a CTT to confirm the positive result. In the universal CTT arm all patients were staged with a CTT. Model probabilities were derived from published literature. Direct costs were obtained from the Medicare procedure database. Our primary outcomes were proportion of true cancers detected, accuracy of and the incremental cost effectiveness ratio (ICER) which evaluates the incremental cost per additional true positive (TP) metastasis identified. RESULTS: The universal CTT strategy resulted in a greater proportion of true cancers detected (TP/baseline prevalence of pulmonary metastases) (93.9%) when compared to CXR (66.7%). However, when the imaging tests were assessed by accuracy (true positive + true negative), the selective CTT staging strategy was found to be more accurate at 93.2% compared to 76.7% for the universal CTT staging strategy. This is balanced by a proportion of false positive (23.2%) in the universal CTT arm compared with 6.6% in the CXR based screening arm. To identify an additional metastasis diagnosed by a universal CTT that would be missed by a CXR based screening strategy would cost $59,931 . Our results are robust to sensitivity analyses evaluating the baseline prevalence of metastasis, but the ICER does vary considerably when the sensitivity of CT imaging was varied. CONCLUSIONS: Our study demonstrates that while a greater proportion of true positive tests are obtained using a universal CT staging strategy this is at the expense of a greater false positive rate. Given the low pretest probability of chest metastasis in patients with cT1a renal masses, there is considerable additional cost associated with screening this population with CTT to identify the few masses that would be missed with CXR based screening protocols. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e542 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Diana Magee More articles by this author Kevin Ginsburg More articles by this author Jared Schober More articles by this author Laura Bukavina More articles by this author Spencer Bell More articles by this author Elizabeth Handorf More articles by this author Alexander Kutikov More articles by this author Robert Uzzo More articles by this author Andres Correa More articles by this author Expand All Advertisement PDF downloadLoading ...