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

描述(申请人提供)：我的目标是通过将经皮射频消融术(RFA)与手术进行比较，确定微创疗法-经皮射频消融术(RFA)-对于偶然发现的微小肾脏肿瘤患者的临床作用。1将使用决策分析方法实现这一目标。首先，我将根据文献和SEER癌症登记的数据，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，来评估RFA和手术的长期有效性。其次，我将收集患者数据，以分别改善与RFA和手术相关的生活质量和成本估计-到目前为止，这些估计要么无法获得，要么在文献中报道得不够充分。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，我将执行广泛的概率敏感度分析，以估计与分析结果相关的不确定性。我的职业目标是通过确定基于成像的技术在癌症患者护理中的最佳角色来改善癌症结果。我追求了一条独特的职业道路，将癌症结果研究、决策分析和放射学结合在一起。我是一个临床部门的一员，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机构的一员。我已经组建了一个决策科学、流行病学、放射学、泌尿学、肿瘤学和病理学的多学科团队，他们目前在我的研究和职业发展方面提供建议，并将在获奖期间继续这样做。我在这份提案中概述的研究和职业发展计划将为正在进行的肾脏肿瘤治疗评估提供坚实的基础，我将从评估过渡到癌症结果研究的独立研究员和领导者。相关性：我的研究将确定经皮射频消融术--一种微创肿瘤疗法--在治疗偶然发现的微小肾肿瘤中的作用。从我的研究中得到的见解将改进射频消融的实践指南，并可能最终排除对偶然发现的小肾肿瘤患者进行手术的需要。

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.