Screening for renal cancer in recipients of kidney transplants.
BACKGROUND
Renal cancer is the most common solid organ cancer in the kidney transplant population with an excess risk ~ 5-fold greater than the general population. It is uncertain whether routine screening for renal cancer is cost-effective. The aim of our study is to estimate the costs and health benefits of ultrasonographic (US) screening for renal cancer in the kidney transplant population.


METHODS
A Markov model was developed to compare the costs and benefits in a cohort of kidney transplant recipients (n = 1000, aged 18-69 years), who underwent annual and biennial US screening for renal cancer, compared with a cohort that did not.


RESULTS
For recipients of kidney transplants aged 18-69 years, the incremental cost-effectiveness ratio (ICER) for routine US screening ranged from $252,100/LYS for biennial screening to $320,988/LYS for annual screening. A total of two and one cancer deaths were averted in the annually and biennially screened population, with a relative cancer-specific mortality reduction by 25% and 12.5%, respectively. Using a series of sensitivity analyses, the ICER was most sensitive to the costs and test specificity of ultrasonography, prevalence of disease, and the risk of graft failure in the screened population.


CONCLUSIONS
Routine screening for renal cancer may reduce the risk of cancer-related deaths in recipients of kidney transplants. Uncertainties, however, exist in the model's influential variables including the risk of graft failure among those who received contrast-enhanced diagnostic computer tomography. Given the available evidence, routine screening for renal cancers may not be cost-effective for recipients of kidney transplants.
Centre for Kidney Research, The Children’s Hospital at Westmead, NSW, Australia. germainw@chw.edu.au
Germaine
G
Wong
Kirsten
K
Howard
Angela C
AC
Webster
Jeremy R
JR
Chapman
Jonathan C
JC
Craig
D000293:Adolescent; D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D007680:Kidney Neoplasms / Q000175:diagnosis* / Q000191:economics / Q000517:prevention & control*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000191:economics*; D008297:Male; D008390:Markov Chains; D008403:Mass Screening / Q000191:economics*; D008875:Middle Aged; D011379:Prognosis; D055815:Young Adult