{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T19:14:08Z","timestamp":1791659648948,"version":"4.3.4"},"reference-count":28,"publisher":"Georg Thieme Verlag KG","issue":"06","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Ultraschall Med"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Purpose\u2002Accurate characterization of testicular lesions is crucial to allow for correct treatment of malignant tumors and to avoid unnecessary procedures in benign ones. In recent years, contrast-enhanced ultrasound (CEUS) proved to be superior in specifying the dignity of small, nonpalpable testicular lesions (&lt;\u200a1.5\u200acm) compared to native B-mode and color Doppler ultrasound which were previously regarded as the primary imaging method. However, the cost-effectiveness of CEUS has not been evaluated yet. The aim of this study was to analyze the cost-effectiveness of CEUS as compared to unenhanced ultrasound for the characterization of nonpalpable testicular lesions.<\/jats:p><jats:p>\n          Methods\u2002A decision model based on Markov simulations estimated lifetime costs and quality-adjusted life years (QALYs) associated with unenhanced ultrasound and CEUS.\u200aModel input parameters were obtained from recent literature. Deterministic sensitivity analysis of diagnostic parameters and costs was performed. Also, probabilistic sensitivity analysis using Monte-Carlo Modelling was applied. The willingness-to-pay (WTP) was set to $100\u200a000\/QALY.<\/jats:p><jats:p>\n          Results\u2002In the base-case scenario, unenhanced ultrasound resulted in total costs of $5113.14 and an expected effectiveness of 8.29 QALYs, whereas CEUS resulted in total costs of $4397.77 with 8.35 QALYs. Therefore, the unenhanced ultrasound strategy was dominated by CEUS in the base-case scenario. Sensitivity analysis showed CEUS to be the cost-effective alternative along a broad range of costs.<\/jats:p><jats:p>\n          Conclusion\u2002Contrast-enhanced ultrasound is a cost-effective imaging method for the characterization of nonpalpable testicular lesions.<\/jats:p>","DOI":"10.1055\/a-1010-5955","type":"journal-article","created":{"date-parts":[[2019,10,9]],"date-time":"2019-10-09T23:20:54Z","timestamp":1570663254000},"page":"668-674","source":"Crossref","is-referenced-by-count":9,"title":["Should We Use Contrast-Enhanced Ultrasound (CEUS) for the Characterization of Nonpalpable Testicular Lesions? An Analysis from\u00a0a Cost-Effectiveness Perspective"],"prefix":"10.1055","volume":"41","author":[{"given":"Johannes","family":"R\u00fcbenthaler","sequence":"first","affiliation":[{"name":"Department of Radiology, Interdisciplinary ultrasound-center, University-Hospital LMU Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Su Hwan","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Radiology, Interdisciplinary ultrasound-center, University-Hospital LMU Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wolfgang G.","family":"Kunz","sequence":"additional","affiliation":[{"name":"Department of Radiology, Interdisciplinary ultrasound-center, University-Hospital LMU Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wieland H.","family":"Sommer","sequence":"additional","affiliation":[{"name":"Department of Radiology, Interdisciplinary ultrasound-center, University-Hospital LMU Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Trottmann","sequence":"additional","affiliation":[{"name":"Department of Urology, University of Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dirk-Andr\u00e9","family":"Clevert","sequence":"additional","affiliation":[{"name":"Department of Radiology, Interdisciplinary ultrasound-center, University-Hospital LMU Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias Frank","family":"Froelich","sequence":"additional","affiliation":[{"name":"Institute of Clinical Radiology and Nuclear Medicine, University Medical Centre Mannheim, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2019,10,9]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1148\/radiol.14132718","article-title":"Differential diagnosis of nonpalpable testicular lesions: qualitative and quantitative contrast-enhanced US of benign and malignant testicular tumors","volume":"273","author":"A M Isidori","year":"2014","journal-title":"Radiology"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1111\/bju.14056","article-title":"Incidentally detected testicular lesions <\u200a10\u200amm in diameter: can orchidectomy be avoided?","volume":"121","author":"G Scandura","year":"2018","journal-title":"BJU Int"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"2268","DOI":"10.1007\/s00330-015-4059-7","article-title":"Incidentally detected non-palpable testicular tumours in adults at scrotal ultrasound: impact of radiological findings on management Radiologic review and recommendations of the ESUR scrotal imaging subcommittee","volume":"26","author":"L Rocher","year":"2016","journal-title":"Eur Radiol"},{"issue":"S 06","key":"ref4","doi-asserted-by":"crossref","first-page":"vi125","DOI":"10.1093\/annonc\/mdt304","article-title":"Testicular seminoma and non-seminoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up","volume":"24","author":"J Oldenburg","year":"2013","journal-title":"Annals of oncology: official journal of the European Society for Medical Oncology\/ESMO"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.1111\/j.1464-410X.2006.06451.x","article-title":"Carefully selected intratesticular lesions can be safely managed with serial ultrasonography","volume":"98","author":"S S Connolly","year":"2006","journal-title":"BJU Int"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"1658","DOI":"10.1093\/annonc\/mdy217","article-title":"ESMO Consensus Conference on testicular germ cell cancer: diagnosis, treatment and follow-up","volume":"29","author":"F Honecker","year":"2018","journal-title":"Annals of oncology: official journal of the European Society for Medical Oncology\/ESMO"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"1675","DOI":"10.1016\/j.ejrad.2015.05.008","article-title":"Growing indications for CEUS: The kidney, testis, lymph nodes, thyroid, prostate, and small bowel","volume":"84","author":"V Cantisani","year":"2015","journal-title":"European journal of radiology"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"554","DOI":"10.1007\/s00330-017-5013-7","article-title":"Dynamic contrast-enhanced and diffusion-weighted MR imaging in the characterisation of small, non-palpable solid testicular tumours","volume":"28","author":"L Manganaro","year":"2018","journal-title":"Eur Radiol"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"1070","DOI":"10.1007\/s00261-018-1816-5","article-title":"MRI of testicular malignancies","volume":"44","author":"A C Tsili","year":"2019","journal-title":"Abdom Radiol (NY)"},{"key":"ref10","doi-asserted-by":"crossref","first-page":"S41","DOI":"10.1259\/bjr\/30029741","article-title":"Focal testicular lesions: colour Doppler ultrasound, contrast-enhanced ultrasound and tissue elastography as adjuvants to the diagnosis","volume":"85 Spec No 1","author":"D Y Huang","year":"2012","journal-title":"The British journal of radiology"},{"key":"ref11","doi-asserted-by":"crossref","first-page":"1807","DOI":"10.1016\/j.ultrasmedbio.2016.03.026","article-title":"Real-Time Elastography and Contrast-Enhanced Ultrasonography in the Evaluation of Testicular Masses: A Comparative Prospective Study","volume":"42","author":"C Schroder","year":"2016","journal-title":"Ultrasound in medicine & biology"},{"key":"ref12","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1016\/j.crad.2010.01.016","article-title":"Re: New ultrasound techniques for imaging of the indeterminate testicular lesion may avoid surgery completely","volume":"65","author":"A Shah","year":"2010","journal-title":"Clin Radiol"},{"key":"ref15","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1111\/j.1872-034X.2011.00936.x","article-title":"Cost-effectiveness analysis on the surveillance for hepatocellular carcinoma in liver cirrhosis patients using contrast-enhanced ultrasonography","volume":"42","author":"H Tanaka","year":"2012","journal-title":"Hepatol Res"},{"key":"ref16","first-page":"280","article-title":"Contrast enhanced ultrasound in focal liver lesions--a cost efficiency study","volume":"12","author":"R Sirli","year":"2010","journal-title":"Med Ultrason"},{"key":"ref17","doi-asserted-by":"crossref","first-page":"e2","DOI":"10.1055\/a-0586-1107","article-title":"The EFSUMB Guidelines and Recommendations for the Clinical Practice of Contrast-Enhanced Ultrasound (CEUS) in Non-Hepatic Applications: Update 2017 (Long Version)","volume":"39","author":"P S Sidhu","year":"2018","journal-title":"Ultraschall in Med"},{"key":"ref18","first-page":"1","article-title":"United States Life Tables, 2014","volume":"66","author":"E Arias","year":"2017","journal-title":"Natl Vital Stat Rep"},{"key":"ref19","doi-asserted-by":"crossref","first-page":"1629","DOI":"10.1002\/cam4.318","article-title":"Testicular self-examination and testicular cancer: a cost-utility analysis","volume":"3","author":"M Aberger","year":"2014","journal-title":"Cancer Med"},{"key":"ref20","doi-asserted-by":"crossref","first-page":"636","DOI":"10.1016\/j.urology.2009.09.053","article-title":"The effects of testicular cancer treatment on health-related quality of life","volume":"75","author":"D J Vidrine","year":"2010","journal-title":"Urology"},{"key":"ref21","doi-asserted-by":"crossref","first-page":"1629","DOI":"10.1007\/s11136-011-9907-6","article-title":"Quality of life among testicular cancer survivors: a case-control study in the United States","volume":"20","author":"C Kim","year":"2011","journal-title":"Qual Life Res"},{"key":"ref22","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1007\/s11136-005-5370-6","article-title":"Scale for chemotherapy-induced long-term neurotoxicity (SCIN): psychometrics, validation, and findings in a large sample of testicular cancer survivors","volume":"15","author":"J Oldenburg","year":"2006","journal-title":"Qual Life Res"},{"key":"ref23","doi-asserted-by":"crossref","first-page":"594","DOI":"10.1200\/JCO.1997.15.2.594","article-title":"International Germ Cell Consensus Classification: a prognostic factor-based staging system for metastatic germ cell cancers. International Germ Cell Cancer Collaborative Group","volume":"15","author":"P M Wilkinson","year":"1997","journal-title":"J Clin Oncol"},{"key":"ref24","doi-asserted-by":"crossref","first-page":"1093","DOI":"10.1001\/jama.2016.12195","article-title":"Recommendations for Conduct, Methodological Practices, and Reporting of Cost-effectiveness Analyses: Second Panel on Cost-Effectiveness in Health and Medicine","volume":"316","author":"G D Sanders","year":"2016","journal-title":"JAMA"},{"key":"ref25","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3310\/hta17160","article-title":"Contrast-enhanced ultrasound using SonoVue(R) (sulphur hexafluoride microbubbles) compared with contrast-enhanced computed tomography and contrast-enhanced magnetic resonance imaging for the characterisation of focal liver lesions and detection of liver metastases: a systematic review and cost-effectiveness analysis","volume":"17","author":"M Westwood","year":"2013","journal-title":"Health Technol Assess"},{"key":"ref27","doi-asserted-by":"crossref","first-page":"1054","DOI":"10.1016\/j.eururo.2015.07.044","article-title":"Guidelines on Testicular Cancer: 2015 Update","volume":"68","author":"P Albers","year":"2015","journal-title":"Eur Urol"},{"key":"ref28","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1055\/s-0044-101254","article-title":"The EFSUMB Guidelines and Recommendations for the Clinical Practice of Contrast-Enhanced Ultrasound (CEUS) in Non-Hepatic Applications: Update 2017 (Short Version)","volume":"39","author":"P S Sidhu","year":"2018","journal-title":"Ultraschall in der Medizin"},{"key":"ref29","doi-asserted-by":"crossref","first-page":"1783","DOI":"10.1097\/01.ju.0000092066.01699.90","article-title":"High incidence of benign testicular neoplasms diagnosed by ultrasound","volume":"170","author":"L Carmignani","year":"2003","journal-title":"J Urol"},{"key":"ref30","doi-asserted-by":"crossref","first-page":"899","DOI":"10.1007\/s00261-018-1510-7","article-title":"Multiparametric US for scrotal diseases","volume":"43","author":"M Bertolotto","year":"2018","journal-title":"Abdom Radiol (NY)"},{"key":"ref31","first-page":"201","article-title":"CEUS Time Intensity Curves in the Differentiation Between Leydig Cell Carcinoma and Seminoma: A Multicenter Study","volume":"37","author":"F M Drudi","year":"2016","journal-title":"Ultraschall in der Medizin"}],"container-title":["Ultraschall in der Medizin - European Journal of Ultrasound"],"original-title":[],"language":"de","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-1010-5955.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,12,8]],"date-time":"2020-12-08T23:42:49Z","timestamp":1607470969000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-1010-5955"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,10,9]]},"references-count":28,"journal-issue":{"issue":"06","published-online":{"date-parts":[[2020,12,8]]},"published-print":{"date-parts":[[2020,12]]}},"URL":"https:\/\/doi.org\/10.1055\/a-1010-5955","relation":{},"ISSN":["0172-4614","1438-8782"],"issn-type":[{"value":"0172-4614","type":"print"},{"value":"1438-8782","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,10,9]]}}}