Economic assessment of contrast-enhanced ultrasonography for evaluation of focal liver lesions: a multicentre Italian experience.
BACKGROUND
The aim of this study was to evaluate the clinical and economic consequences of the introduction of contrast-enhanced ultrasonography (CEUS) into the diagnostic clinical algorithm for the characterization of incidental focal liver lesions (FLLs).


METHODS
This prospective study enrolled 485 subjects at three hospitals in Italy. Two diagnostic algorithms were utilized: (1) a classic patient work-up, which included baseline US followed by a CT or MR examination, and (2) a new patient management scheme in which, following the baseline US, a CEUS examination was performed. For each pathway, both direct and indirect health costs for the National Health System (NHS) at two of the three hospitals involved in the study were calculated. Clinical outcome was measured in terms of number of cases correctly diagnosed, using contrast-enhanced CT/contrast-enhanced MR as the reference standard.


RESULTS
CEUS correctly differentiated (benign vs. malignant) 559 of 575 lesions (97.2%), with a sensitivity of 98.1% and a specificity of 95.7%. Histological characterization was correct in 502 of 575 lesions (87%) with a sensitivity of 90.5% and a specificity of 85.4%. In terms of cost, the conventional diagnostic algorithm incurred for the NHS a total cost of Euro 134.576,60 vs. Euro 55.674,30 with CEUS, for a saving of Euro 78.902 (Euro 162 per patient). For the hospitals, the total cost was Euro 147.045 without CEUS vs Euro 61.979 with CEUS, for a saving of Euro 85.065,96 or Euro 175,39 per patient.


CONCLUSIONS
The routine use of CEUS for the characterization of FLLs provides significant cost savings, both for the NHS and for the hospital.
Romanini
Laura
L
Diagnostic Imaging Department, Spedali Civili di Brescia, Piazzale Spedali Civili 1, 25125 Brescia, Italy. laura.romanini@libero.it
Passamonti
Matteo
M
Aiani
Luca
L
Cabassa
Paolo
P
Raieli
Giuseppina
G
Montermini
Ilaria
I
Martegani
Alberto
A
Grazioli
Luigi
L
Calliada
Fabrizio
F
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D003287:Contrast Media / Q000191:economics*; D003952:Diagnostic Imaging; D005260:Female; D006801:Humans; D007558:Italy; D008107:Liver Diseases / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D010743:Phospholipids / Q000191:economics*; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013459:Sulfur Hexafluoride / Q000191:economics*; D014463:Ultrasonography / Q000191:economics* / Q000379:methods
D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride