Cost-Effectiveness Analysis Comparing Biopsy in Advance of Ablation with Concurrent Biopsy and Ablation for Small Renal Masses Measuring 1-3 cm.
J Vasc Interv Radiol
; 35(9): 1388-1396.e5, 2024 Sep.
Article
en En
| MEDLINE
| ID: mdl-38759884
ABSTRACT
PURPOSE:
To analyze the cost effectiveness of performing a renal mass biopsy in advance of ablation or concurrently with a percutaneous ablation procedure for the management of small renal masses (SRMs). MATERIALS ANDMETHODS:
A decision-analytic model was developed with a cohort of 65-year-old male patients with an incidental, unilateral 1-3 cm SRM. A decision tree modeled the first year of clinical intervention, after which patients entered a Markov model with a lifetime horizon. Patients were assumed to be treated in accordance with established clinical practice guidelines, including surveillance, repeat ablation for recurrence, and systemic therapy for metastasis. Healthcare cost and utility values were determined from published literature or local hospital estimates, discounted at 1.5%. Total lifetime costs were calculated from the perspective of a Canadian healthcare payer and converted to 2022 Canadian dollars (C$). The primary outcome was incremental cost-effectiveness ratio (ICER) at a willingness-to-pay threshold of C$50,000 per quality-adjusted life year (QALY) gained. The secondary outcome was ICER at a willingness-to-pay threshold of C$50,000 per life year (LY) gained.RESULTS:
Concurrent biopsy and ablation resulted in a gain of 16.4 quality-adjusted days, at an incremental cost of $386, with an ICER of C$8,494/QALY. The concurrent strategy was the dominant strategy for a prevalence of benign mass of <5%. Sequential biopsy and ablation was only cost-effective when LYs were not quality-adjusted and ablation cost was >C$4,300 or benign mass prevalence was >28%.CONCLUSIONS:
Concurrent biopsy and ablation is cost-effective relative to pretreatment diagnostic biopsy for management of incidental SRMs.
Texto completo:
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Base de datos:
MEDLINE
Asunto principal:
Cadenas de Markov
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Técnicas de Apoyo para la Decisión
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Costos de la Atención en Salud
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Análisis Costo-Beneficio
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Modelos Económicos
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Años de Vida Ajustados por Calidad de Vida
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Neoplasias Renales
Idioma:
En
Revista:
J Vasc Interv Radiol
/
J. vasc. interv. radiol
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Journal of vascular and interventional radiology
Asunto de la revista:
ANGIOLOGIA
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RADIOLOGIA
Año:
2024
Tipo del documento:
Article