Cost-effectiveness of Contrast-enhanced Ultrasound for Diagnosis and Active Surveillance of Complex Cystic Renal Lesions

Purpose:The aim of this study was to determine the cost-effectiveness of contrast-enhanced ultrasound for the active surveillance of complex renal masses compared to the more established imaging modalities of CT and MRI.Methods:A decision-analytic Markov state microsimulation model was constructed in TreeAge Pro. We simulated independent cohorts of 100,000 60-year-old individuals with either a Bosniak IIF or Bosniak III complex renal mass who were followed for 10 years or until death. The model compared 3 imaging strategies: (1) contrast-enhanced ultrasound, (2) contrast-enhanced magnetic-resonance imaging, and (3) contrast-enhanced computed tomography for active surveillance of a complex renal mass.Results:For 60-year-old patients with either Bosniak IIF or III renal masses, contrast-enhanced ultrasound was the most cost-effective strategy even after varying rates of active surveillance from 10%-100%.Conclusion:Contrast-enhanced ultrasound is a viable and cost-effective option in the active surveillance of Bosniak class IIF and III renal cysts. Even after varying the rates of active surveillance usage, contrast-enhanced ultrasound was robust and remained the most dominant strategy. For patients who have impaired kidney functions, contrast-enhanced ultrasound is can be a safer alternative than noncontrast enhanced CT or MRI in the management of patients with Bosniak III renal cysts.