Should We Use Contrast-Enhanced Ultrasound (CEUS) for the Characterization of Nonpalpable Testicular Lesions? An Analysis from a Cost-Effectiveness Perspective

Abstract

Purpose Accurate characterization of testicular lesions is crucial to allow for correct treatment of malignant tumors and to avoid unnecessary procedures in benign ones. In recent years, contrast-enhanced ultrasound (CEUS) proved to be superior in specifying the dignity of small, nonpalpable testicular lesions (< 1.5 cm) compared to native B-mode and color Doppler ultrasound which were previously regarded as the primary imaging method. However, the cost-effectiveness of CEUS has not been evaluated yet. The aim of this study was to analyze the cost-effectiveness of CEUS as compared to unenhanced ultrasound for the characterization of nonpalpable testicular lesions.

Methods A decision model based on Markov simulations estimated lifetime costs and quality-adjusted life years (QALYs) associated with unenhanced ultrasound and CEUS. Model input parameters were obtained from recent literature. Deterministic sensitivity analysis of diagnostic parameters and costs was performed. Also, probabilistic sensitivity analysis using Monte-Carlo Modelling was applied. The willingness-to-pay (WTP) was set to $100 000/QALY.

Results In the base-case scenario, unenhanced ultrasound resulted in total costs of $5113.14 and an expected effectiveness of 8.29 QALYs, whereas CEUS resulted in total costs of $4397.77 with 8.35 QALYs. Therefore, the unenhanced ultrasound strategy was dominated by CEUS in the base-case scenario. Sensitivity analysis showed CEUS to be the cost-effective alternative along a broad range of costs.

Conclusion Contrast-enhanced ultrasound is a cost-effective imaging method for the characterization of nonpalpable testicular lesions.

Zusammenfassung

Ziel Die korrekte Charakterisierung von Hodenläsionen ist entscheidend für die Einleitung der korrekten Behandlung bei malignen Tumoren sowie zur Vermeidung unnötiger Prozeduren bei benignen Tumoren. In den letzten Jahren erwies sich der kontrastmittelverstärkte Ultraschall (CEUS) zur Bestimmung der Dignität von kleinen, nichtpalpablen Hodenläsionen (< 1,5 cm) als überlegen, verglichen mit dem nativen B-Mode- und Farbdoppler-Ultraschall, welche zuvor als die primären Bildgebungsmethoden angesehen wurden. Jedoch wurde die Kosteneffektivität von CEUS in diesem Zusammenhang noch nicht analysiert. Ziel dieser Studie war es, die Kosteneffektivität von CEUS hinsichtlich der Charakterisierung nichtpalpabler Hodenläsionen im Vergleich zum nativen Ultraschall zu evaluieren.

Material und Methoden Ein Entscheidungsmodell basierend auf Markov-Simulationen errechnete die mit einer nativen Ultraschalluntersuchung sowie CEUS assoziierten Quality-Adjusted Life-Years (QALY). Die Input-Parameter basierten auf der aktuell verfügbaren Literatur. Deterministische und probabalistische Sensitivitätsanalysen basierend auf Monte-Carlo-Simulationen (PSA) wurden verwendet, um die Unsicherheit der Modellergebnisse zu schätzen. Die Willingness-to-Pay (WTP) wurde mit 100 000$/QALY festgelegt.

Ergebnisse In der Base-Case-Analyse für eine WTP von 100 000$ pro QALY resultierte der native Ultraschall in Gesamtkosten von 5113,14$ bei einer erwarteten Effektivität von 8,29 QALYs, während CEUS zu Gesamtkosten von 4397,77$ bei 8,35 QALYs führte. Somit wird die Strategie nativer Ultraschall von der Strategie CEUS in der Base-Case-Analyse dominiert.

Schlussfolgerung CEUS ist eine kosteneffektive Bildgebungsmethode zur Charakterisierung nichtpalpabler Hodenläsionen.

Key words

ultrasound - cost-effectiveness - contrast-enhanced ultrasound - testicular cancer

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