Department of Urology, University of Virginia, Charlottesville, VA.
University of Virginia School of Medicine, Charlottesville, VA.
Urology. 2024 Jun;188:111-117. doi: 10.1016/j.urology.2024.04.007. Epub 2024 Apr 20.
To examine the cost-effectiveness of the clear cell likelihood score compared to renal mass biopsy (RMB) alone.
The clear cell likelihood score, a new grading system based on multiparametric magnetic resonance imaging, has been proposed as a possible alternative to percutaneous RMB for identifying clear cell renal carcinoma in small renal masses and expediting treatment of high-risk patients. A decision analysis model was developed to compare a RMB strategy where all patients undergo biopsy and a clear cell likelihood score strategy where only patients that received an indeterminant score of 3 undergo biopsy. Effectiveness was assigned 1 for correct diagnoses and 0 for incorrect or indeterminant diagnoses. Costs were obtained from institutional fees and Medicare reimbursement rates. Probabilities were derived from literature estimates from radiologists trained in the clear cell likelihood score.
In the base case model, the clear cell likelihood score was both more effective (0.77 vs 0.70) and less expensive than RMB ($1629 vs $1966). Sensitivity analysis found that the nondiagnostic rate of RMB and the sensitivity of the clear cell likelihood score had the greatest impact on the model. In threshold analyses, the clear cell likelihood score was the preferred strategy when its sensitivity was greater than 62.7% and when an MRI cost less than $5332.
The clear cell likelihood score is a more cost-effective option than RMB alone for evaluating small renal masses for clear cell renal carcinoma.
研究与单纯肾肿瘤活检（RMB）相比，透明细胞可能性评分的成本效益。
透明细胞可能性评分是一种新的分级系统，基于多参数磁共振成像，被提议作为一种替代经皮 RMB 的方法，用于识别小肾肿瘤中的透明细胞肾细胞癌，并加快高危患者的治疗。开发了一个决策分析模型，以比较一种 RMB 策略，即所有患者都进行活检，以及一种透明细胞可能性评分策略，即只有接受不确定评分 3 的患者进行活检。有效性赋值为 1（正确诊断），0（错误或不确定诊断）。成本来自机构收费和医疗保险报销率。概率来自接受过透明细胞可能性评分培训的放射科医生的文献估计。
在基本模型中，透明细胞可能性评分在有效性（0.77 比 0.70）和成本效益（1629 美元比 1966 美元）方面均优于 RMB。敏感性分析发现，RMB 的非诊断率和透明细胞可能性评分的敏感性对模型影响最大。在阈值分析中，当透明细胞可能性评分的敏感性大于 62.7%且 MRI 成本低于 5332 美元时，该评分是首选策略。
与单纯 RMB 相比，透明细胞可能性评分是评估透明细胞肾细胞癌小肾肿瘤的更具成本效益的选择。
