Cost-effectiveness model of renal cell carcinoma (RCC) surveillance in Hereditary Leiomyomatosis and Renal Cell Carcinoma (HLRCC)

Alexander J Thompson, Yousef M. Alwan, Vijay A. C. Ramani, D. Gareth Evans, Eamonn R Maher, Emma R. Woodward

Research output: Contribution to journalArticlepeer-review


Purpose: To determine the cost-effectiveness of annual renal imaging surveillance (RIS) in Hereditary Leiomyomatosis and Renal Cell Cancer (HLRCC). HLRCC is associated with a 21% risk to age 70-years of RCC. Presentations with advanced RCC are associated with poor outcomes whereas RIS detects early-stage RCC; however, evidence for the cost-effectiveness of RIS is lacking.

Methods: We developed a decision-analytic model to compare, at different age starting points (11-years, 18-years, 40-years, 60-years), the costs and benefits of lifetime contrast-enhanced renal magnetic resonance imaging surveillance (CERMRIS) versus no surveillance in HLRCC. Benefits were measured in life-years gained (LYG), quality adjusted life years (QALYs), and costs in GBP. Net-monetary-benefit (NMB) was calculated using a cost-effectiveness threshold of £20,000/QALY. One-way sensitivity and probabilistic analyses were also performed.

Results: In the base-case 11-year age cohort, surveillance was cost-effective [Incremental_NMB=£3,522 (95% CIs:-£2747_£7652); Incremental_LYG=1.25 (95% CIs:0.30_1.86); Incremental_QALYs=0.29 (95% CIs:0.07_0.43)] at an additional mean discounted cost of £2,185/patient (95% CIs:£430_£4,144). Surveillance was also cost-effective in other age cohorts and dominated a no surveillance strategy in the 40-year cohort [Incremental_NMB=£12,655 (95% CIs:-£709_£21,134); Incremental_LYG=1.52 (95%CIs:0.30_2.26); Incremental_QALYs=0.58 (95%CIs: 0.12_0.87) with a cost saving of £965/patient (95%CIs:-£4202_£2652).

Conclusion: Annual CERMRI in HLRCC is cost-effective across age groups modelled.
Original languageEnglish
JournalJournal of Medical Genetics
Publication statusAccepted/In press - 12 Jan 2022


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