title: Contrast-enhanced ultrasonography in the evaluation of incidental focal liver lesions: A cost-effectiveness analysis.
abstract: OBJECTIVE
  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).
  
  
  CONCLUSIONS
  While the costs of CEUS and CT in evaluating FLLs are comparable, CEUS examination is far more cost-effective in comparison to MRI.
authors: Miriama Smajerova, Hana Petrasova, Jirina Little, Tomas Andrasina, Vlastimil Valek, Eva Nemcova, Barbora Miklosova, Department of Radiology, University Hospital Brno, 62500 Brno, Czech Republic.
authors: Miriama
authors: M
authors: Smajerova
authors: Miriama Smajerova, Hana Petrasova, Jirina Little, Tomas Andrasina, Vlastimil Valek, Eva Nemcova, Barbora Miklosova, Department of Radiology, University Hospital Brno, 62500 Brno, Czech Republic.
authors: Hana
authors: H
authors: Petrasova
authors: Miriama Smajerova, Hana Petrasova, Jirina Little, Tomas Andrasina, Vlastimil Valek, Eva Nemcova, Barbora Miklosova, Department of Radiology, University Hospital Brno, 62500 Brno, Czech Republic.
authors: Jirina
authors: J
authors: Little
authors: Miriama Smajerova, Hana Petrasova, Jirina Little, Tomas Andrasina, Vlastimil Valek, Eva Nemcova, Barbora Miklosova, Department of Radiology, University Hospital Brno, 62500 Brno, Czech Republic.
authors: Petra
authors: P
authors: Ovesna
authors: Miriama Smajerova, Hana Petrasova, Jirina Little, Tomas Andrasina, Vlastimil Valek, Eva Nemcova, Barbora Miklosova, Department of Radiology, University Hospital Brno, 62500 Brno, Czech Republic.
authors: Tomas
authors: T
authors: Andrasina
authors: Miriama Smajerova, Hana Petrasova, Jirina Little, Tomas Andrasina, Vlastimil Valek, Eva Nemcova, Barbora Miklosova, Department of Radiology, University Hospital Brno, 62500 Brno, Czech Republic.
authors: Vlastimil
authors: V
authors: Valek
authors: Miriama Smajerova, Hana Petrasova, Jirina Little, Tomas Andrasina, Vlastimil Valek, Eva Nemcova, Barbora Miklosova, Department of Radiology, University Hospital Brno, 62500 Brno, Czech Republic.
authors: Eva
authors: E
authors: Nemcova
authors: Miriama Smajerova, Hana Petrasova, Jirina Little, Tomas Andrasina, Vlastimil Valek, Eva Nemcova, Barbora Miklosova, Department of Radiology, University Hospital Brno, 62500 Brno, Czech Republic.
authors: Barbora
authors: B
authors: Miklosova
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media / Q000737:chemistry; D003362:Cost-Benefit Analysis; D018153:Czech Republic; D005260:Female; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000191:economics*; D008279:Magnetic Resonance Imaging / Q000191:economics*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed / Q000191:economics*; D014463:Ultrasonography / Q000191:economics*; D055815:Young Adult
chemical_list: D003287:Contrast Media
keywords: Computed tomography; Contrast-enhanced ultrasonography; Economic analysis; Focal liver lesion; Magnetic resonance imaging