K. O. Memeh1, M. A. Guerrero1, F. B. Maegawa1,2 1University Of Arizona,General Surgery,Tucson, AZ, USA 2Southern Arizona VA Health Care System,Surgery,Tucson, AZ, USA
Introduction:
There is significant global variation in both society guidelines and clinical practice regarding the surveillance of an initially diagnosed non-functional, radiologically-benign adrenal incidentaloma. Given the low likelihood of these lesions becoming functional or malignant, some clinician have questioned the utility of frequent long term surveillance ( FLTS) strategy compared to no surveillance(NS) strategy. We sought to evaluate and compare the cost effectiveness of current guidelines in the United States ( FLTS) and Europe( NS). We hypothesized that the FLTS strategy would not be a cost effective approach to managing this group of patients.
Methods:
A Markov transition- state model was created comparing the FLTS and NS strategy for a 60 year old patient diagnosed with a non-functional, non-malignant adrenal incidentaloma after adequate initial work up. Cost estimates were obtained from published Healthcare Cost and Utilization Project and Medicare reimbursement databases. Utility and outcome probabilities were estimated from published literature. Sensitivity analysis was performed to determine the uncertainty of cost, outcome probability and utility estimates on the model. A threshold of $ 100,000/ quality adjusted life year ( QALY) was used to determine cost effectiveness.
Results:
The FLTS strategy produced an incremental cost of $12,521 with incremental effectiveness of 0.26 QALY giving an incremental cost- effectiveness ratio ( ICER) of $181,773/QALY which exceeds the $100,000/QALY threshold for cost effectiveness. The FLTS strategy was not cost effective and this result was confirmed on multi-way sensitivity analysis using Monte Carlo simulation.
Conclusion:
Frequent long term surveillance ( as described in the current US adrenal incidentaloma guideline) is not a cost effective strategy for the management of non-functional, radiologically-benign adrenal incidentaloma.
