Cost-Effectiveness of Radiofrequency Ablation for Small, Incidental Renal Tumors

描述（由申请人提供）：我的目标是通过比较RFA和手术（目前的标准护理），确定微创治疗-经皮射频消融(RFA) -对偶然发现的小肾肿瘤患者的临床作用。我将使用决策分析方法来实现这一目标。首先，我将根据文献和SEER癌症登记处的数据，通过开发一个计算机模型来模拟偶然发现的肾脏肿瘤的自然历史，从而估计RFA和手术的长期有效性。其次，我将收集患者数据，分别改善与RFA和手术相关的生活质量和成本估算——这些估算要么无法获得，要么在迄今为止的文献中报道不足。第三，我将进行成本效益分析，利用获得的有效性、生活质量和成本数据，将RFA与手术进行比较。最后，我将进行广泛的概率敏感性分析，以估计与分析结果相关的不确定性。我的职业目标是通过定义成像技术在癌症患者护理中的最佳作用来改善癌症治疗结果。我追求的是一条独特的职业道路，集癌症结果研究、决策分析和放射学于一体。我是临床部门的一员，该部门是肾肿瘤RFA的大型转诊中心，也是一个拥有丰富资源支持决策分析研究的结果研究所。我组建了一个包括决策科学、流行病学、放射学、泌尿学、肿瘤学和病理学在内的多学科团队，他们目前为我的研究和职业发展提供建议，并将在奖励期间继续这样做。我在这份提案中概述的研究和职业发展计划将为我正在进行的肾脏肿瘤治疗评估提供坚实的基础，从这个基础上我将过渡到一个独立的研究者和癌症结局研究的领导者。相关性：我的研究将建立经皮射频消融-一种微创肿瘤治疗-在治疗偶然发现的小肾肿瘤中的作用。我的研究见解将改进射频消融术使用的实践指南，并可能最终排除偶然发现的小肾肿瘤患者手术的需要。

DESCRIPTION (provided by applicant): My goal is to determine the clinical role of a minimally invasive therapy - percutaneous radiofrequency ablation (RFA) - for patients with small, incidentally detected renal tumors, by comparing RFA to surgery, the current standard of care. 1 will accomplish this goal using a decision-analytic approach. First, I will estimate the long-term effectiveness of RFA and surgery by developing a computer model that simulates the natural history of incidentally detected renal tumors, based on data from the literature and the SEER cancer registry. Second, I will collect patient data to improve quality-of-life and cost estimates associated with RFA and surgery, respectively - these estimates are either unavailable or insufficiently reported in the literature to, date. Third, I will perform a cost-effectiveness analysis in which I will compare RFA to surgery, using the effectiveness, quality-of-life, and cost data obtained. Finally, I will perform an extensive, probabilistic sensitivity analysis to estimate the uncertainty associated with analysis results. My career objective is to improve cancer outcomes by defining the best roles for imaging-based technologies in the care of cancer patients. I have pursued a unique career path that integrates cancer outcomes research, decision analysis, and radiology. I am part of a clinical division that serves as a large referral center for renal tumor RFA, and an outcomes research institute that has a wealth of resources to support decision analysis research. I have formulated a multidisciplinary team in decision science, epidemiology, radiology, urology, oncology, and pathology who currently advise in my research and career development, and will continue to do so during the award period. The research and career development plan that I outline in this proposal will provide me with a solid foundation for ongoing renal tumor therapy evaluation, from which I will transition to an independent investigator and leader in cancer outcomes research. RELEVANCE: My research will establish the role of percutaneous radiofrequency ablation - a minimally invasive tumor therapy - in the treatment of small, incidentally detected renal tumors. Insights from my research will improve practice guidelines for the use of radiofrequency ablation, and may ultimately preclude the need for surgery in patients with small, incidentally detected renal tumors.