Cost Effectiveness of Staging Methods in Renal Cell Carcinoma

Moon, Woe Chul; Kim, Young Kyoon

Abstract

Recently computed tomography, angiography, ultrasonography, bone scan and liver scan have been used in staging of renal cell carcinoma. However routine use of all these methods may not be necessary and cost effective. Herein we analyzed 71 cases. Computed tomography was as good as angiography, but better than ultrasonography in diagnostic accuracy. Ultrasonography was unsatisfactory in staging of abdominal extent. Computed tomography was as good as angiography in staging I and III a, but better in staging II and IIIb. Computed tomography also found metastasis to bone, lung, liver and lymph node. Computed tomography done at O. P. D. costs less than ultrasonography, angiography and computed tomography done during admission. The former costs less than the latter by about 360,000 Won in insurance cases and 520,000 Won in non-insurance cases. The specificity of bone scan was 77 %. Of 17 patients with bone metastasis, 10 (59 %) showed elevated serum alkaline phosphatase, only 2 (12%) elevated serum Ca. and 4 (24 %) complained bone pain. All 3 patients with liver metastasis showed definite abnormality on liver function test. We conclude that the most cost effective staging system in renal cell carcinoma is routine computed tomography and bone scan and chest P. A done at O.P.D.