Diagnostic Workup for Patients with Solid Renal Masses: A Cost-Effectiveness Analysis

SIMPLE SUMMARY: There are several benign and malignant types of solid renal masses. For diagnostic and characterization of these masses, a few imaging methods such as magnetic resonance imaging (MRI), computed tomography (CT) or (contrast-enhanced) ultrasound (CEUS) are established in the clinical routine. The aim of our study was to assess the most economical approach for detecting and characterizing these masses. As a result, contrast-enhanced ultrasound turned out to be a cost-effective diagnostic method. Therefore, if available, this method should be considered in the routine. Alternatively, MRI also offers excellent diagnostic accuracy, but it is associated with higher costs. This result may lead to a change in the diagnostic workup of solid renal masses in clinical routine, as contrast-enhanced ultrasound should be considered as an appropriate method for the first analysis compared to CT and MRI. ABSTRACT: Background: For patients with solid renal masses, a precise differentiation between malignant and benign tumors is crucial for forward treatment management. Even though MRI and CT are often deemed as the gold standard in the diagnosis of solid renal masses, CEUS may also offer very high sensitivity in detection. The aim of this study therefore was to evaluate the effectiveness of CEUS from an economical point of view. Methods: A decision-making model based on a Markov model assessed expenses and utilities (in QALYs) associated with CEUS, MRI and CT. The utilized parameters were acquired from published research. Further, a Monte Carlo simulation-based deterministic sensitivity analysis of utilized variables with 30,000 repetitions was executed. The willingness-to-pay (WTP) is at USD 100,000/QALY. Results: In the baseline, CT caused overall expenses of USD 10,285.58 and an efficacy of 11.95 QALYs, whereas MRI caused overall expenses of USD 7407.70 and an efficacy of 12.25. Further, CEUS caused overall expenses of USD 5539.78, with an efficacy of 12.44. Consequently, CT and MRI were dominated by CEUS, and CEUS remained cost-effective in the sensitivity analyses. Conclusions: CEUS should be considered as a cost-effective imaging strategy for the initial diagnostic workup and assessment of solid renal masses compared to CT and MRI.