Comparison of Magnetic Resonance Imaging and Contrast-Enhanced Ultrasound as Diagnostic Options for Unclear Cystic Renal Lesions: A Cost-Effectiveness Analysis

Abstract

Purpose Correct differentiation between malignant and benign incidentally found cystic renal lesions has critical implications for patient management. In several studies contrast-enhanced ultrasound (CEUS) showed higher sensitivity with respect to the accurate characterization of these lesions compared to MRI, but the cost-effectiveness of CEUS has yet to be investigated. The aim of this study was to analyze the cost-effectiveness of CEUS as an alternative imaging method to MRI for the characterization of incidentally found cystic renal lesions.

Materials and Methods A decision model including the diagnostic modalities MRI and CEUS was created based on Markov simulations estimating lifetime costs and quality-adjusted life years (QALYs). The recent literature was reviewed to obtain model input parameters. The deterministic sensitivity of diagnostic parameters and costs was determined and probabilistic sensitivity analysis using Monte-Carlo Modelling was applied. Willingness-to-pay (WTP) was assumed to be $ 100 000/QALY.

Results In the base-case scenario, the total costs for CEUS were $9654.43, whereas the total costs for MRI were $9675.03. CEUS resulted in an expected effectiveness of 8.06 QALYs versus 8.06 QALYs for MRI. Therefore, from an economic point of view, CEUS was identified as an adequate diagnostic alternative to MRI. Sensitivity analysis showed that results may vary if CEUS costs increase or those of MRI decrease.

Conclusion Based on the results of the analysis, the use of CEUS was identified as a cost-effective diagnostic strategy for the characterization of incidentally found cystic renal lesions.

Zusammenfassung

Ziel Die Unterscheidung zwischen malignen und benignen zufällig entdeckten zystischen Läsionen der Niere ist essenziell für weitere Behandlungsstrategien. In einigen Studien zeigte kontrastverstärkter Ultraschall (CEUS) im Vergleich zur Magnetresonanztomografie (MRT) eine höhere Sensitivität bei der Charakterisierung dieser Läsionen. Eine Analyse der Kosteneffektivität von CEUS steht jedoch noch aus. Das Ziel dieser Studie war es, die Kosteneffektivität von CEUS als alternative bildgebende Methode zur MRT bei der Charakterisierung zufällig entdeckter zystischer Nierenläsionen zu analysieren.

Material and Methode Basierend auf Markov-Simulationen wurde unter Einbezug der Modalitäten MRT und CEUS ein Entscheidungsmodell entwickelt, welches die „lifetime costs” und die „Quality-adjusted life-years “(QALYs) der Methoden analysiert. Die Modellparameter wurden durch Recherche aktueller Literatur gewonnen. Es wurden die deterministische Sensitivität der Parameter sowie die Kosten bestimmt. Mittels Monte-Carlo-Modellierung wurde eine probabilistische Sensitivitätsanalyse durchgeführt. Die „Willingness to pay” (WTP) wurde auf $100 000/QALY festgelegt.

Ergebnisse Im Base-case-Szenario ergaben sich für CEUS absolute Kosten von $ 9654,43 und für MRT von $ 9675,03. Die erwartete Effektivität lag sowohl bei CEUS als auch bei MRT bei 8,06 QALYs. Aus ökonomischer Sicht konnte CEUS daher als sinnvolle Alternative zur MRT identifiziert werden. Die Sensitivitätsanalyse zeigte, dass diese Ergebnisse abhängig von den Kosten von CEUS und MRT variieren können.

Schlussfolgerung Basierend auf den Ergebnissen dieser Studie konnte CEUS als kosteneffektive diagnostische Alternative gegenüber MRT in Bezug auf die Charakterisierung zufällig entdeckter zystischer Nierenläsionen identifiziert werden.

Key words

ultrasound - contrast-enhanced ultrasound - cost effectiveness - renal lesions - magnetic resonance imaging

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