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与手术（目前的标准治疗），确定微创治疗-经皮射频消融（RFA）-在偶然发现的小型肾肿瘤患者中的临床作用。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癌症登记处的数据，通过开发一个模拟偶然发现的肾肿瘤自然史的计算机模型来估计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-这些估计在迄今为止的文献中不可用或报告不足。第三，我将进行成本效益分析，其中我将使用所获得的有效性、生活质量和成本数据比较RFA与手术。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基于成像的技术在癌症患者护理中的最佳作用来改善癌症预后。我追求的是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部分，该部门是肾肿瘤RFA的大型转诊中心，也是一个结局研究机构，拥有丰富的资源支持决策分析研究。我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，他们目前为我的研究和职业发展提供建议，并将在获奖期间继续这样做。我在本提案中概述的研究和职业发展计划将为我持续的肾肿瘤治疗评估提供坚实的基础，从那时起，我将过渡到癌症结局研究的独立研究者和领导者。相关性：我的研究将建立经皮射频消融术的作用-一种微创肿瘤治疗-在治疗小的，偶然发现的肾脏肿瘤。从我的研究中获得的见解将改善射频消融术的使用实践指南，并可能最终排除小的偶然发现的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.