Cost‐effectiveness analysis of multiple imaging modalities in diagnosis and follow‐up of intermediate complex cystic renal lesions

Autor: Markus H. Lerchbaumer, Bernd Hamm, Yano Wehrenberg, Paul Spiesecke, Andreas Maxeiner, Thomas Reinhold, Jonas Busch, Sven Werner, Thomas Fischer
Rok vydání: 2021
Předmět:
#uroonc
medicine.medical_specialty
cystic renal lesion
Cost-Benefit Analysis
Urology
Contrast Media
Computed tomography
Malignancy
030218 nuclear medicine & medical imaging
Imaging modalities
Hospitals
University
03 medical and health sciences
0302 clinical medicine
medicine
Humans
magnetic resonance imaging
health care economics and organizations
Aged
Ultrasonography
contrast-enhanced ultrasonography
#kcsm
medicine.diagnostic_test
business.industry
030503 health policy & services
cost-effectiveness analysis
computed tomography
Magnetic resonance imaging
Health Care Costs
Gold standard (test)
Cost-effectiveness analysis
Kidney Diseases
Cystic
Middle Aged
University hospital
medicine.disease
Kidney Neoplasms
Markov Chains
#KidneyCancer
Quality-Adjusted Life Years
Radiology
Tomography
X-Ray Computed
0305 other medical science
business
600 Technik
Medizin
angewandte Wissenschaften::610 Medizin und Gesundheit::610 Medizin und Gesundheit
Contrast-enhanced ultrasound
Zdroj: BJU International. 128:575-585
ISSN: 1464-410X
1464-4096
DOI: 10.1111/bju.15353
Popis: Objectives: To compare health-economic aspects of multiple imaging modalities used to monitor renal cysts, the present study evaluates costs and outcomes of patients with Bosniak IIF and III renal cysts detected and followed-up by either contrast-enhanced computed tomography (ceCT), contrast-enhanced magnetic resonance imaging (ceMRI), or contrast-enhanced ultrasonography (CEUS). Patients and methods: A simulation using Markov models was implemented and performed with 10 cycles of 1 year each. Proportionate cohorts were allocated to Markov models by a decision tree processing specific incidences of malignancy and levels of diagnostic performance. Costs of imaging and surgical treatment were investigated using internal data of a European university hospital. Multivariate probabilistic sensitivity analysis was performed to confirm results considering input value uncertainties. Patient outcomes were measured in quality-adjusted life years (QALY), and costs as averages per patient including costs of imaging and surgical treatment. Results: Compared to the 'gold standard' of ceCT, ceMRI was more effective but also more expensive, with a resulting incremental cost-effectiveness ratio (ICER) >€70 000 (Euro) per QALY gained. CEUS was dominant compared to ceCT in both Bosniak IIF and III renal cysts in terms of QALYs and costs. Probabilistic sensitivity analysis confirmed these results in the majority of iterations. Conclusion: Both ceMRI and CEUS can be used as alternatives to ceCT in the diagnosis and follow-up of intermediately complex cystic renal lesions without compromising effectiveness, while CEUS is clearly cost-effective. The economic results apply to a large university hospital and must be adapted for smaller hospitals.
Databáze: OpenAIRE
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