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Less is more: cost-effectiveness analysis of surveillance strategies for small, nonfunctional, radiographically benign adrenal incidentalomas.
- Author(s): Chomsky-Higgins, Kathryn
- Seib, Carolyn
- Rochefort, Holly
- Gosnell, Jessica
- Shen, Wen T
- Kahn, James G
- Duh, Quan-Yang
- Suh, Insoo
- et al.
Published Web Locationhttps://ac.els-cdn.com/S0039606017305998/1-s2.0-S0039606017305998-main.pdf?_tid=0819a2e4-cbf2-11e7-83ac-00000aacb35d&acdnat=1510962784_8e48761651d2a9d6602ddc0576b81ecb
No data is associated with this publication.
BackgroundGuidelines for management of small adrenal incidentalomas are mutually inconsistent. No cost-effectiveness analysis has been performed to evaluate rigorously the relative merits of these strategies.
MethodsWe constructed a decision-analytic model to evaluate surveillance strategies for <4cm, nonfunctional, benign-appearing adrenal incidentalomas. We evaluated 4 surveillance strategies: none, one-time, annual for 2 years, and annual for 5 years. Threshold and sensitivity analyses assessed robustness of the model. Costs were represented in 2016 US dollars and health outcomes in quality-adjusted life-years.
ResultsNo surveillance has an expected net cost of $262 and 26.22 quality-adjusted life-years. One-time surveillance costs $158 more and adds 0.2 quality-adjusted life-years for an incremental cost-effectiveness ratio of $778/quality-adjusted life-years. The strategies involving more surveillance were dominated by the no surveillance and one-time surveillance strategies less effective and more expensive. Above a 0.7% prevalence of adrenocortical carcinoma, one-time surveillance was the most effective strategy. The results were robust to all sensitivity analyses of disease prevalence, sensitivity, and specificity of diagnostic assays and imaging as well as health state utility.
ConclusionFor patients with a < 4cm, nonfunctional, benign-appearing mass, one-time follow-up evaluation involving a noncontrast computed tomography and biochemical evaluation is cost-effective. Strategies requiring more surveillance accrue more cost without incremental benefit.
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