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Cost-effectiveness of dual-energy CT versus multiphasic single-energy CT and MRI for characterization of incidental indeterminate renal lesions

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Abstract

Purpose

To evaluate the cost-effectiveness of DECT versus multiphasic CT and MRI for characterizing small incidentally detected indeterminate renal lesions using a Markov Monte Carlo decision-analytic model.

Background

Incidental renal lesions are commonly encountered due to the increasing utilization of medical imaging and the increasing prevalence of renal lesions with age. Currently recommended imaging modalities to further characterize incidental indeterminate renal lesions have some inherent drawbacks. Single-phase DECT may overcome these limitations, but its cost-effectiveness remains uncertain.

Materials and methods

A decision-analytic (Markov) model was constructed to estimate life expectancy and lifetime costs for otherwise healthy 64-year-old patients with small (≤ 4 cm) incidentally detected, indeterminate renal lesions on routine imaging (e.g., ultrasound or single-phase CT). Three strategies for evaluating renal lesions for enhancement were compared: multiphase SECT (e.g., true unenhanced and nephrographic phase), multiphasic MRI, and single-phase DECT (nephrographic phase in dual-energy mode). The model incorporated modality-specific diagnostic test performance, incidence, and prevalence of incidental renal cell carcinomas (RCCs), effectiveness, costs, and health outcomes. An incremental cost-effectiveness analysis was performed to identify strategy preference at willingness-to-pay (WTP) thresholds of $50,000 and $100,000 per quality-adjusted life-year (QALY) gained. Deterministic and probabilistic sensitivity analysis were performed.

Results

In the base case analysis, expected mean costs per patient undergoing characterization of incidental renal lesions were $2567 for single-phase DECT, $3290 for multiphasic CT, and $3751 for multiphasic MRI. Associated quality-adjusted life-years were the highest for single-phase DECT at 0.962, for multiphasic MRI it was 0.940, and was the lowest for multiphasic CT at 0.925. Because of lower associated costs and higher effectiveness, the single-phase DECT strategy dominated the other two strategies.

Conclusions

Single-phase DECT is potentially more cost-effective than multiphasic SECT and MRI for evaluating small incidentally detected indeterminate renal lesions.

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Authors and Affiliations

  1. Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr., Stanford, CA, 94305, USA

    Bhavik N. Patel, Domenico Mastrodicasa & R. Brooke Jeffrey

  2. Siemens Healthineers, 40 Liberty Boulevard, Malvern, PA, 19355, USA

    Artem T. Boltyenkov & Maria G. Martinez

  3. Department of Radiology, Duke University Medical Center, Box 3808, Erwin Rd, Durham, NC, 27710, USA

    Daniele Marin

  4. Department of Urology, Stanford University School of Medicine, 300 Pasteur Dr., Stanford, CA, 94305, USA

    Benjamin Chung

  5. Department of Radiology, Institute for Technology Assessment, Massachusetts General Hospital, 101 Merrimac St, Boston, MA, 02114, USA

    Pari Pandharipande

  6. Department of Radiology, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, White 270, Boston, MA, 02114, USA

    Avinash Kambadakone

  7. Division of Abdominal Imaging, Dept. of Radiology, Stanford University School of Medicine, Stanford, USA

    Bhavik N. Patel

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  1. Bhavik N. Patel
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Correspondence to Bhavik N. Patel.

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BNP—research support (GE and Siemens), speaker’s bureau (GE). AB & GM—employees of Siemens. DM, RJ, BC, PP, and AK—no relevant disclosures. DaM—research support (Siemens).

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Patel, B.N., Boltyenkov, A.T., Martinez, M.G. et al. Cost-effectiveness of dual-energy CT versus multiphasic single-energy CT and MRI for characterization of incidental indeterminate renal lesions. Abdom Radiol 45, 1896–1906 (2020). https://doi.org/10.1007/s00261-019-02380-x

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