Cost-Effective Strategies for Small Renal Masses Active surveillance (AS) for small renal masses has emerged as a reasonable management option for many patients. Initial AS, followed by delayed intervention depending on subsequent tumor growth and patient choice, appears safe given low rates of early metastatic potential. Su et al (page 794) report on a cost-effectiveness model assessing different treatment options for incidental masses less than 2 cm, including AS or immediate ablation/surgery, in a multicenter center study.1 The main finding is AS followed by delayed intervention is most cost-effective compared to up-front surgery or thermal ablation. Clinical decision analyses show age, individual preferences, and health status were important factors shaping optimal management. Although some of the conclusions become limited when considering somewhat larger renal masses, the authors conclude that as the probability of metastatic progression decreases (ie ≤2 cm) AS will realize higher health utilities than the other approaches.
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