Screening for renal cancer in recipients of kidney transplants
Date
2011
Authors
Wong, G.
Howard, K.
Webster, A.C.
Chapman, J.R.
Craig, J.C.
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Journal article
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Nephrology Dialysis Transplantation, 2011; 26(5):1729-1739
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Abstract
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 reducethe risk of cancer-related deaths in recipients of kidney transplants.Uncertainties, however, exist in the model's influentialvariables including the risk of graft failure among thosewho receivedcontrast-enhanced diagnostic computer tomography.Given the available evidence, routine screening for renal cancersmay not be cost-effective for recipients of kidney transplants.
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Copyright 2010 The Author. Published by Oxford University Press on behalf of ERA-EDTA.
Access Condition Notes: This article is free to read online