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Introduction:
We assessed the cost-effectiveness of percutaneous renal mass biopsy (RMB) to guide management decisions for small solid enhancing renal masses (SRM, ≤4cm).
Materials & Methods:
We developed a decision-analytic model estimating the costs and benefits of RMB prior to competing treatments: percutaneous/laparoscopic ablation, laparoscopic/open partial nephrectomy, laparoscopic/open radical nephrectomy. For RMB, we modeled a 10% non-diagnostic rate, 97.5% sensitivity, 91.2% specificity and 0.01% complication rate. Positive or non-diagnostic RMB led to treatment; negative RMB led to active surveillance. Our base case was a healthy 65-year old patient with an asymptomatic unilateral 3cm SRM. Model inputs were estimated from the literature. Outcomes were measured in quality-adjusted life-years (QALY) and 2008 US\ respectively. We used a societal perspective, lifetime horizon, 3% discount rate, 3-month cycle length, and a \,000/QALY willingness-to-pay threshold. The model Results and alternative clinical scenarios were tested with sensitivity analysis.
Results:
In the base case, RMB was cost-effective prior to radical nephrectomy options for all scenarios. Conversely, for partial nephrectomy or ablation options, management without prior RMB was cost-effective; however, RMB was cost-effective with smaller tumors, younger and less healthy patients (Figure).
Conclusions:
For healthy 65-year old patients, RMB is cost-effective to guide management of any SRM prior to radical nephrectomy. It is also recommended for patients with smaller SRM, younger age, and worse health prior to partial nephrectomy or ablative therapies.