MP57-01 COST-EFFECTIVE MANAGEMENT OF SMALL RENAL MASSES: THE ROLE OF TUMOR BIOPSY

Abstract

You have accessJournal of UrologyKidney Cancer: Surgical Therapy II1 Apr 2015MP57-01 COST-EFFECTIVE MANAGEMENT OF SMALL RENAL MASSES: THE ROLE OF TUMOR BIOPSY Michael Rydberg, and Sangtae Park Michael RydbergMichael Rydberg More articles by this author , and Sangtae ParkSangtae Park More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.1989AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Incidental small solid renal masses (SRM) are being increasingly diagnosed during abdominal imaging. Since ∼25% of these SRM's are benign and modern SRM biopsy techniques have become more accurate, empiric SRM treatment may not be cost-effective. In this study, we evaluated the cost-effectiveness of percutaneous biopsy as the initial step in SRM treatment using a Markov modeling approach. METHODS The TreeAge Pro Healthcare Suite® (Williamstown, MA) was used to develop a Markov model on 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. Multiple 1- and 2-way sensitivity analyses were performed to evaluate the model. RESULTS The Markov model demonstrated that SRM biopsy prior to surgery was always more cost effective than empiric SRM treatment, regardless of surgical approach. Specifically, three of the nine treatment options were most cost-effective: active surveillance (AS), biopsy before cryoablation (biopsy +/- cryo), and biopsy before robotic partial nephrectomy (biopsy +/- RPN). While AS was the cheapest 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. 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 age 76, and remained cost-effective through age 90, when AS became dominant. CONCLUSIONS Our study demonstrates 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. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e689 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Rydberg More articles by this author Sangtae Park More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...