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 renal cell cancer (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 MRI surveillance (CERMRIS) vs no surveillance in HLRCC. Benefits were measured in life-years gained (LYG), quality-adjusted life years (QALYs) and costs in British Pounds Sterling (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=£3522 (95% CI -£2747 to £7652); Incremental_LYG=1.25 (95% CI 0.30 to 1.86); Incremental_QALYs=0.29 (95% CI 0.07 to 0.43)] at an additional mean discounted cost of £2185/patient (95% CI £430 to £4144). 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 to £21 134); Incremental_LYG=1.52 (95% CI 0.30 to 2.26); Incremental_QALYs=0.58 (95% CI 0.12 to 0.87) with a cost saving of £965/patient (95% CI -£4202 to £2652).

CONCLUSION: Annual CERMRI in HLRCC is cost-effective across age groups modelled.

Original languageEnglish
Pages (from-to)41-47
Number of pages7
JournalJournal of Medical Genetics
Issue number1
Early online date4 Feb 2022
Publication statusPublished - 23 Dec 2022


  • Female
  • Humans
  • Aged
  • Child
  • Carcinoma, Renal Cell/diagnosis
  • Cost-Benefit Analysis
  • Leiomyomatosis/diagnosis
  • Kidney Neoplasms/diagnosis
  • Quality-Adjusted Life Years


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