Cost-effectiveness of Contrast-Enhanced Ultrasound for Diagnosis and Active Surveillance of Complex Cystic Renal Lesions.

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To determine the cost-effectiveness of Contrast-Enhanced Ultrasound (ceUS) for the active surveillance of complex renal masses compared to the more established imaging modalities of CT and MRI. A decision-analytic Markov state microsimulation model was constructed in TreeAge Pro. We simulated independent cohorts of 100,000 60-year-old individuals with either a Bosniak IIF or Bosniak III complex renal mass who were followed for 10 years or until death. The model compared three imaging strategies: (1) ceUS, (2) contrast-enhanced magnetic-resonance imaging (ceMRI), and (3) contrast-enhanced computed tomography (ceCT) for active surveillance of a complex renal mass. For 60-year-old patients with either Bosniak IIF or III renal masses, ceUS was the most cost-effective strategy even after varying rates of active surveillance from 10-100%. ceUS is a viable and cost-effective option in the active surveillance of Bosniak class IIF and III renal cysts. Even after varying the rates of active surveillance usage, ceUS was robust and remained the most dominant strategy. For patients who have impaired kidney functions, ceUS is can be a safer alternative than non-contrast enhanced CT or MRI in the management of patients with Bosniak III renal cysts.