title: The cost-effectiveness of immediate treatment, percutaneous biopsy and active surveillance for the diagnosis of the small solid renal mass: evidence from a Markov model.
abstract: OBJECTIVE
  The most effective diagnostic strategy for the very small, incidentally detected solid renal mass is uncertain. We assessed the cost-effectiveness of adding percutaneous biopsy or active surveillance to the diagnosis of a 2 cm or less solid renal mass.
  
  
  METHODS
  A Markov state transition model was developed to observe a hypothetical cohort of healthy 60-year-old men with an incidentally detected, 2 or less cm solid renal mass, comparing percutaneous biopsy, immediate treatment and active surveillance. The primary outcomes assessed were the incremental cost-effectiveness ratio measured by cost per life-year gained at a willingness to pay threshold of $50,000. Model results were assessed by sensitivity analysis.
  
  
  RESULTS
  Immediate treatment was the highest cost, most effective diagnostic strategy, providing the longest overall survival of 18.53 life-years. Active surveillance was the lowest cost, least effective diagnostic strategy. On cost-effectiveness analysis using a societal willingness to pay threshold of $50,000 active surveillance was the preferred choice at a $75,000 willingness to pay threshold while biopsy and treatment were acceptable ($56,644 and $70,149 per life-year, respectively). When analysis was adjusted for quality of life, biopsy dominated immediate treatment as the most cost-effective diagnostic strategy at $33,840 per quality adjusted life-year gained.
  
  
  CONCLUSIONS
  Percutaneous biopsy may have a greater role in optimizing the diagnosis of an incidentally detected, 2 cm or less solid renal mass.
authors.affiliation: Department of Radiology and Division of Urology, University of Utah, Salt Lake City, Utah, USA. marta.heilbrun@hsc.utah.edu
authors.forename: Marta E
authors.initials: ME
authors.lastname: Heilbrun
authors.forename: Junhua
authors.initials: J
authors.lastname: Yu
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Smith
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Dechet
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Zagoria
authors.forename: Mark S
authors.initials: MS
authors.lastname: Roberts
mesh_terms: D001707:Biopsy, Needle / Q000191:economics; D003362:Cost-Benefit Analysis; D006801:Humans; D007680:Kidney Neoplasms / Q000191:economics* / Q000473:pathology / Q000628:therapy; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D011159:Population Surveillance; D012680:Sensitivity and Specificity; D013997:Time Factors