title: Intraprocedural contrast-enhanced ultrasound (CEUS) in liver percutaneous radiofrequency ablation: clinical impact and health technology assessment.
abstract: OBJECTIVE
  To assess the clinical and the economic impacts of intraprocedural use of contrast-enhanced ultrasound (CEUS) in patients undergoing percutaneous radiofrequency ablation for small (<2.5 cm) hepatocellular carcinomas.
  
  
  METHODS
  One hundred and forty-eight hepatocellular carcinomas in 93 patients were treated by percutaneous radiofrequency ablation and immediate assessment by intraprocedural CEUS. Clinical impact, cost effectiveness, and budget, organisational and equity impacts were evaluated and compared with standard treatment without intraprocedural CEUS using the health technology assessment approach.
  
  
  RESULTS
  Intraprocedural CEUS detected incomplete ablation in 34/93 (36.5 %) patients, who underwent additional treatment during the same session. At 24-h, complete ablation was found in 88/93 (94.6 %) patients. Thus, a second session of treatment was spared in 29/93 (31.1 %) patients. Cost-effectiveness analysis revealed an advantage for the use of intraprocedural CEUS in comparison with standard treatment (4,639 vs 6,592) with a 21.9 % reduction of the costs to treat the whole sample. Cost per patient for complete treatment was <euro> 4,609 versus <euro> 5,872 respectively. The introduction of intraprocedural CEUS resulted in a low organisational impact, and in a positive impact on equity
  
  
  CONCLUSIONS
  Intraprocedural use of CEUS has a relevant clinical impact, reducing the number of re-treatments and the related costs per patient.
  
  
  CONCLUSIONS
  • CEUS allows to immediately asses the result of ablation. • Intraprocedural CEUS decreases the number of second ablative sessions. • Intraprocedural CEUS may reduce cost per patient for complete treatment. • Use of intraprocedural CEUS may reduce hospital budget. • Its introduction has low organisational impact, and relevant impact on equity.
authors.affiliation: IRCCS Policlinico San Donato, Unit of Radiology, Piazza Malan 2-20097 San Donato Milanese, Milano, Italy, vanni.mauri@gmail.com.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Mauri
authors.forename: Emanuele
authors.initials: E
authors.lastname: Porazzi
authors.forename: Luca
authors.initials: L
authors.lastname: Cova
authors.forename: Umberto
authors.initials: U
authors.lastname: Restelli
authors.forename: Tania
authors.initials: T
authors.lastname: Tondolo
authors.forename: Marzia
authors.initials: M
authors.lastname: Bonfanti
authors.forename: Anna
authors.initials: A
authors.lastname: Cerri
authors.forename: Tiziana
authors.initials: T
authors.lastname: Ierace
authors.forename: Davide
authors.initials: D
authors.lastname: Croce
authors.forename: Luigi
authors.initials: L
authors.lastname: Solbiati