Presentation (CTI)

OBJECTIVES: There is no clinical consensus on optimal follow-up strategies for people who have completed treatment for localised or locally advanced renal cell carcinoma (RCC). Evidence from the multinational RECUR study, including UK participants, suggests that increased imaging scans during follow up has little survival benefit. This study assessed the cost-effectiveness of different risk-stratified follow-up strategies.
METHODS: A lifetime semi-Markov model was developed in R to compare the cost effectiveness of two follow-up strategies for people who have undergone nephrectomy. The strategies compared were high proportion versus a low proportion of cross-sectional imaging strategy (“low CSI” and “high CSI”), and a low versus a high imaging frequency strategy (“low IF” and “high IF”). The population was stratified by recurrence risk: low, intermediate and high. Recurrence rates, survival following recurrence and probability of detecting recurrence were derived from the RECUR study. Parametric models were fitted to the Kaplan-Meier curves to extrapolate long-term recurrence and survival outcomes. Resource use, costs and utility values were sourced from published literature reviews, NICE technology appraisals and national sources.
RESULTS: The high CSI strategy had an ICER of £3,392 in the low-risk group and of £5,137 in the intermediate-risk group, whereas the high IF strategy had an ICER of £15,811 in the low-risk group, and £12,345 in the intermediate-risk group. For high-risk group, the high CSI strategy was dominated by the low CSI strategy, while the high IF strategy had an ICER of £26,697 compared with the low IF strategy.
CONCLUSIONS: High CSI and high IF strategies appear to be cost effective in the low- and intermediate-risk groups. In the high-risk group, high CSI appeared not to be cost-effective while the cost-effectiveness of high IF remains uncertain, due to low-quality evidence and lack of detail on number and types of scans per strategy in the RECUR study.