Prospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 14, 2016; 22(38): 8605-8614
Published online Oct 14, 2016. doi: 10.3748/wjg.v22.i38.8605
Contrast-enhanced ultrasonography in the evaluation of incidental focal liver lesions: A cost-effectiveness analysis
Miriama Smajerova, Hana Petrasova, Jirina Little, Petra Ovesna, Tomas Andrasina, Vlastimil Valek, Eva Nemcova, Barbora Miklosova
Miriama Smajerova, Hana Petrasova, Jirina Little, Tomas Andrasina, Vlastimil Valek, Eva Nemcova, Barbora Miklosova, Department of Radiology, University Hospital Brno, 62500 Brno, Czech Republic
Miriama Smajerova, Hana Petrasova, Jirina Little, Tomas Andrasina, Vlastimil Valek, Eva Nemcova, Barbora Miklosova, Faculty of Medicine, Masaryk University, 62500 Brno, Czech Republic
Petra Ovesna, Institute of Biostatistics and Analyses, Masaryk University, 62500 Brno, Czech Republic
Author contributions: Smajerova M, Petrasova H and Andrasina T designed the study; Smajerova M, Miklosova B and Nemcova E performed the research; Ovesna P analysed the data; Smajerova M, Petrasova H and Little J wrote the paper; and Valek V revised the manuscript for final submission.
Supported by Masaryk University, No. MUNI/A/1083/2015.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the University Hospital Brno.
Informed consent statement: Patients were not required to give informed consent for this study because retrospective data collection and analysis used anonymous clinical data that were obtained after each patient’s agreement to examination by written consent.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hana Petrasova, MD, Department of Radiology, University Hospital Brno, Jihlavska 20, 62500 Brno, Czech Republic. petrasovahana@gmail.com
Telephone: +420-532-233007 Fax: +420-532-233699
Received: June 27, 2016
Peer-review started: June 28, 2016
First decision: July 29, 2016
Revised: August 26, 2016
Accepted: September 12, 2016
Article in press: September 12, 2016
Published online: October 14, 2016
Processing time: 106 Days and 22.8 Hours
Abstract
AIM

To determine whether contrast-enhanced ultrasonography (CEUS) as the first-line method is more cost-effective in evaluating incidentally discovered focal liver lesions (FLLs) than is computed tomography (CT) and magnetic resonance imaging (MRI).

METHODS

Between 2010 and 2015, our prospective study enrolled 459 patients with incidentally found FLLs. The biological nature of FLLs was assessed by CEUS in all patients. CT or MRI examinations were added in unclear cases. The sensitivity and specificity of CEUS were calculated. The total costs of CEUS examinations and of the added examinations performed in inconclusive cases were calculated. Afterwards, the theoretical expenses for evaluating incidentally discovered FLLs using CT or MRI as the first-line method were calculated. The results were compared.

RESULTS

The total cost of the diagnostic process using CEUS for all enrolled patients with FLLs was 75884 USD. When the expenses for additional CT and MRI examinations performed in inconclusive cases were added, the total cost was 90540 US dollar (USD). If all patients had been examined by CT or MR as the first-line method, the costs would have been 78897 USD or 384235 USD, respectively. The difference between the cost of CT and CEUS was 3013 USD (4%) and that between MRI and CEUS was 308352 USD (406.3%). We correctly described 97.06% of benign or malignant lesions, with 96.99% sensitivity and 97.09% specificity. Positive predictive value was 94.16% and negative predictive value was 98.52%. In cases with 4 and more lesions, malignancy is significantly more frequent and inconclusive findings significantly less frequent (P < 0.001).

CONCLUSION

While the costs of CEUS and CT in evaluating FLLs are comparable, CEUS examination is far more cost-effective in comparison to MRI.

Keywords: Contrast-enhanced ultrasonography; Focal liver lesion; Computed tomography; Magnetic resonance imaging; Economic analysis

Core tip: Diagnosing focal liver lesions (FLLs) is a part of everyday practice, and therefore the cost-effectiveness of their diagnosis is important. Our study compared the costs of contrast-enhanced ultrasonography (CEUS), computed tomography (CT) and magnetic resonance imaging (MRI) in assessing the biological nature of FLL. We have proven significant savings when using CEUS instead of MRI. The costs of CEUS and CT examinations can be considered comparable. There exist additional parameters which influence the efficacy of individual modalities.