Cost-effectiveness model of renal cell carcinoma (RCC) surveillance in hereditary leiomyomatosis and renal cell carcinoma (HLRCC)

Alexander J. Thompson; Yousef M Alwan; Vijay A. C. Ramani; D. Gareth Evans; Eamonn R. Maher; Emma R. Woodward

doi:10.1136/jmedgenet-2021-108215

Cost-effectiveness model of renal cell carcinoma (RCC) surveillance in hereditary leiomyomatosis and renal cell carcinoma (HLRCC)

Alexander J. Thompson, Yousef M Alwan, Vijay A. C. Ramani, D. Gareth Evans, Eamonn R. Maher, Emma R. Woodward

Aston Medical School

Research output: Contribution to journal › Article › peer-review

8 Citations (SciVal)

Abstract

PURPOSE: To determine the cost-effectiveness of annual renal imaging surveillance (RIS) in hereditary leiomyomatosis and renal cell cancer (HLRCC). HLRCC is associated with a 21% risk to age 70 years of RCC. Presentations with advanced renal cell cancer (RCC) are associated with poor outcomes whereas RIS detects early-stage RCC; however, evidence for the cost-effectiveness of RIS is lacking.

METHODS: We developed a decision-analytic model to compare, at different age starting points (11 years, 18 years, 40 years, 60 years), the costs and benefits of lifetime contrast-enhanced renal MRI surveillance (CERMRIS) vs no surveillance in HLRCC. Benefits were measured in life-years gained (LYG), quality-adjusted life years (QALYs) and costs in British Pounds Sterling (GBP). Net monetary benefit (NMB) was calculated using a cost-effectiveness threshold of £20 000/QALY. One-way sensitivity and probabilistic analyses were also performed.

RESULTS: In the base-case 11-year age cohort, surveillance was cost-effective (Incremental_NMB=£3522 (95% CI -£2747 to £7652); Incremental_LYG=1.25 (95% CI 0.30 to 1.86); Incremental_QALYs=0.29 (95% CI 0.07 to 0.43)] at an additional mean discounted cost of £2185/patient (95% CI £430 to £4144). Surveillance was also cost-effective in other age cohorts and dominated a no surveillance strategy in the 40 year cohort [Incremental_NMB=£12 655 (95% CIs -£709 to £21 134); Incremental_LYG=1.52 (95% CI 0.30 to 2.26); Incremental_QALYs=0.58 (95% CI 0.12 to 0.87) with a cost saving of £965/patient (95% CI -£4202 to £2652).

CONCLUSION: Annual CERMRI in HLRCC is cost-effective across age groups modelled.

Original language	English
Pages (from-to)	41-47
Number of pages	7
Journal	Journal of Medical Genetics
Volume	60
Issue number	1
Early online date	4 Feb 2022
DOIs	https://doi.org/10.1136/jmedgenet-2021-108215
Publication status	Published - 23 Dec 2022

Funding

ERM acknowledges support from the NIHR Cambridge Biomedical Research Centre, ERW from Cancer Research UK (C64726/A30910), and ERW and DGE from the Manchester NIHR Biomedical Research Centre (IS-BRC1215-20007). The University of Cambridge has received salary support (ERM) from the NHS in the East of England through the Clinical Academic Reserve.

Funders	Funder number
Manchester Biomedical Research Centre	IS-BRC1215-20007
National Institute for Health and Care Research
Cancer Research UK	C64726/A30910

Keywords

Female
Humans
Aged
Child
Carcinoma, Renal Cell/diagnosis
Cost-Benefit Analysis
Leiomyomatosis/diagnosis
Kidney Neoplasms/diagnosis
Quality-Adjusted Life Years

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10.1136/jmedgenet-2021-108215

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@article{51153cacac8c4bec876232049332045f,

title = "Cost-effectiveness model of renal cell carcinoma (RCC) surveillance in hereditary leiomyomatosis and renal cell carcinoma (HLRCC)",

abstract = "PURPOSE: To determine the cost-effectiveness of annual renal imaging surveillance (RIS) in hereditary leiomyomatosis and renal cell cancer (HLRCC). HLRCC is associated with a 21% risk to age 70 years of RCC. Presentations with advanced renal cell cancer (RCC) are associated with poor outcomes whereas RIS detects early-stage RCC; however, evidence for the cost-effectiveness of RIS is lacking.METHODS: We developed a decision-analytic model to compare, at different age starting points (11 years, 18 years, 40 years, 60 years), the costs and benefits of lifetime contrast-enhanced renal MRI surveillance (CERMRIS) vs no surveillance in HLRCC. Benefits were measured in life-years gained (LYG), quality-adjusted life years (QALYs) and costs in British Pounds Sterling (GBP). Net monetary benefit (NMB) was calculated using a cost-effectiveness threshold of £20 000/QALY. One-way sensitivity and probabilistic analyses were also performed.RESULTS: In the base-case 11-year age cohort, surveillance was cost-effective (Incremental_NMB=£3522 (95% CI -£2747 to £7652); Incremental_LYG=1.25 (95% CI 0.30 to 1.86); Incremental_QALYs=0.29 (95% CI 0.07 to 0.43)] at an additional mean discounted cost of £2185/patient (95% CI £430 to £4144). Surveillance was also cost-effective in other age cohorts and dominated a no surveillance strategy in the 40 year cohort [Incremental_NMB=£12 655 (95% CIs -£709 to £21 134); Incremental_LYG=1.52 (95% CI 0.30 to 2.26); Incremental_QALYs=0.58 (95% CI 0.12 to 0.87) with a cost saving of £965/patient (95% CI -£4202 to £2652).CONCLUSION: Annual CERMRI in HLRCC is cost-effective across age groups modelled.",

keywords = "Female, Humans, Aged, Child, Carcinoma, Renal Cell/diagnosis, Cost-Benefit Analysis, Leiomyomatosis/diagnosis, Kidney Neoplasms/diagnosis, Quality-Adjusted Life Years",

author = "Thompson, {Alexander J.} and Alwan, {Yousef M} and Ramani, {Vijay A. C.} and Evans, {D. Gareth} and Maher, {Eamonn R.} and Woodward, {Emma R.}",

year = "2022",

month = dec,

day = "23",

doi = "10.1136/jmedgenet-2021-108215",

language = "English",

volume = "60",

pages = "41--47",

journal = "Journal of Medical Genetics",

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publisher = "BMJ Publishing Group",

number = "1",

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TY - JOUR

T1 - Cost-effectiveness model of renal cell carcinoma (RCC) surveillance in hereditary leiomyomatosis and renal cell carcinoma (HLRCC)

AU - Thompson, Alexander J.

AU - Alwan, Yousef M

AU - Ramani, Vijay A. C.

AU - Evans, D. Gareth

AU - Maher, Eamonn R.

AU - Woodward, Emma R.

PY - 2022/12/23

Y1 - 2022/12/23

N2 - PURPOSE: To determine the cost-effectiveness of annual renal imaging surveillance (RIS) in hereditary leiomyomatosis and renal cell cancer (HLRCC). HLRCC is associated with a 21% risk to age 70 years of RCC. Presentations with advanced renal cell cancer (RCC) are associated with poor outcomes whereas RIS detects early-stage RCC; however, evidence for the cost-effectiveness of RIS is lacking.METHODS: We developed a decision-analytic model to compare, at different age starting points (11 years, 18 years, 40 years, 60 years), the costs and benefits of lifetime contrast-enhanced renal MRI surveillance (CERMRIS) vs no surveillance in HLRCC. Benefits were measured in life-years gained (LYG), quality-adjusted life years (QALYs) and costs in British Pounds Sterling (GBP). Net monetary benefit (NMB) was calculated using a cost-effectiveness threshold of £20 000/QALY. One-way sensitivity and probabilistic analyses were also performed.RESULTS: In the base-case 11-year age cohort, surveillance was cost-effective (Incremental_NMB=£3522 (95% CI -£2747 to £7652); Incremental_LYG=1.25 (95% CI 0.30 to 1.86); Incremental_QALYs=0.29 (95% CI 0.07 to 0.43)] at an additional mean discounted cost of £2185/patient (95% CI £430 to £4144). Surveillance was also cost-effective in other age cohorts and dominated a no surveillance strategy in the 40 year cohort [Incremental_NMB=£12 655 (95% CIs -£709 to £21 134); Incremental_LYG=1.52 (95% CI 0.30 to 2.26); Incremental_QALYs=0.58 (95% CI 0.12 to 0.87) with a cost saving of £965/patient (95% CI -£4202 to £2652).CONCLUSION: Annual CERMRI in HLRCC is cost-effective across age groups modelled.

AB - PURPOSE: To determine the cost-effectiveness of annual renal imaging surveillance (RIS) in hereditary leiomyomatosis and renal cell cancer (HLRCC). HLRCC is associated with a 21% risk to age 70 years of RCC. Presentations with advanced renal cell cancer (RCC) are associated with poor outcomes whereas RIS detects early-stage RCC; however, evidence for the cost-effectiveness of RIS is lacking.METHODS: We developed a decision-analytic model to compare, at different age starting points (11 years, 18 years, 40 years, 60 years), the costs and benefits of lifetime contrast-enhanced renal MRI surveillance (CERMRIS) vs no surveillance in HLRCC. Benefits were measured in life-years gained (LYG), quality-adjusted life years (QALYs) and costs in British Pounds Sterling (GBP). Net monetary benefit (NMB) was calculated using a cost-effectiveness threshold of £20 000/QALY. One-way sensitivity and probabilistic analyses were also performed.RESULTS: In the base-case 11-year age cohort, surveillance was cost-effective (Incremental_NMB=£3522 (95% CI -£2747 to £7652); Incremental_LYG=1.25 (95% CI 0.30 to 1.86); Incremental_QALYs=0.29 (95% CI 0.07 to 0.43)] at an additional mean discounted cost of £2185/patient (95% CI £430 to £4144). Surveillance was also cost-effective in other age cohorts and dominated a no surveillance strategy in the 40 year cohort [Incremental_NMB=£12 655 (95% CIs -£709 to £21 134); Incremental_LYG=1.52 (95% CI 0.30 to 2.26); Incremental_QALYs=0.58 (95% CI 0.12 to 0.87) with a cost saving of £965/patient (95% CI -£4202 to £2652).CONCLUSION: Annual CERMRI in HLRCC is cost-effective across age groups modelled.

KW - Female

KW - Humans

KW - Aged

KW - Child

KW - Carcinoma, Renal Cell/diagnosis

KW - Cost-Benefit Analysis

KW - Leiomyomatosis/diagnosis

KW - Kidney Neoplasms/diagnosis

KW - Quality-Adjusted Life Years

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DO - 10.1136/jmedgenet-2021-108215

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JO - Journal of Medical Genetics

JF - Journal of Medical Genetics

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ER -

Cost-effectiveness model of renal cell carcinoma (RCC) surveillance in hereditary leiomyomatosis and renal cell carcinoma (HLRCC)

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