Cost-Effectiveness Analysis of the Clear Cell Likelihood Score Against Renal Mass Biopsy for Evaluating Small Renal Masses.

OBJECTIVE: To examine the cost-effectiveness of the clear cell likelihood score compared to renal mass biopsy (RMB) alone. METHODS: The clear cell likelihood score, a new grading system based on multiparametric magnetic resonance imaging, has been proposed as a possible alternative to percutaneous RMB for identifying clear cell renal carcinoma in small renal masses and expediting treatment of high-risk patients. A decision analysis model was developed to compare a RMB strategy where all patients undergo biopsy and a clear cell likelihood score strategy where only patients that received an indeterminant score of 3 undergo biopsy. Effectiveness was assigned 1 for correct diagnoses and 0 for incorrect or indeterminant diagnoses. Costs were obtained from institutional fees and Medicare reimbursement rates. Probabilities were derived from literature estimates from radiologists trained in the clear cell likelihood score. RESULTS: In the base case model, the clear cell likelihood score was both more effective (0.77 vs 0.70) and less expensive than RMB ($1629 vs $1966). Sensitivity analysis found that the nondiagnostic rate of RMB and the sensitivity of the clear cell likelihood score had the greatest impact on the model. In threshold analyses, the clear cell likelihood score was the preferred strategy when its sensitivity was greater than 62.7% and when an MRI cost less than $5332. CONCLUSION: The clear cell likelihood score is a more cost-effective option than RMB alone for evaluating small renal masses for clear cell renal carcinoma.

Factors influencing knee adduction moment measurement: A systematic review and meta-regression analysis.

The external knee adduction moment has been identified as a key biomarker in biomechanics research, with associations with this variable and degenerative diseases such as knee osteoarthritis. Heterogeneity in participant characteristics and the protocols used to measure this variable may however complicate its interpretation. Previous reviews have focused on interventions or did not control for potential moderator variables in their analysis. In this meta-regression analysis, we aimed to determine the influence of factors including the cohort type, footwear, and walking speed on the measurement of knee adduction moment. We performed a systematic review of the literature, identifying articles that used the Plug-in-Gait inverse dynamics model to calculate the knee adduction moment during level walking, and used a mixed effect model to determine the effect of the previously described factors on the measurement. Results for 861 individuals were described in 19 articles. Walking speed had the largest influence on knee adduction moment (p<0.001), and participants with medial knee osteoarthritis had an increased knee adduction moment (p=0.008) compared to healthy subjects. Footwear was found to have a significant overall effect (p=0.024). Participants tested barefoot or wearing their own shoes had lower adduction moments than those tested in footwear provided by the researchers. Overall, the moderators accounted for 60% of the heterogeneity in the results. These results support the hypothesis that an increased knee adduction moment is associated with medial compartment knee osteoarthritis, and that footwear choice can influence the results. Gait speed has the largest effect on knee adduction moment measurement and should be carefully controlled for in studies investigating this variable.