{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T07:48:44Z","timestamp":1782287324627,"version":"3.54.5"},"reference-count":34,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2021,3,18]],"date-time":"2021-03-18T00:00:00Z","timestamp":1616025600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bjui-journals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJU International"],"published-print":{"date-parts":[[2021,11]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To compare health\u2010economic aspects of multiple imaging modalities used to monitor renal cysts, the present study evaluates costs and outcomes of patients with Bosniak IIF and III renal cysts detected and followed\u2010up by either contrast\u2010enhanced computed tomography (ceCT), contrast\u2010enhanced magnetic resonance imaging (ceMRI), or contrast\u2010enhanced ultrasonography (CEUS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and Methods<\/jats:title>\n                    <jats:p>A simulation using Markov models was implemented and performed with 10 cycles of 1\u00a0year each. Proportionate cohorts were allocated to Markov models by a decision tree processing specific incidences of malignancy and levels of diagnostic performance. Costs of imaging and surgical treatment were investigated using internal data of a European university hospital. Multivariate probabilistic sensitivity analysis was performed to confirm results considering input value uncertainties. Patient outcomes were measured in quality\u2010adjusted life years (QALY), and costs as averages per patient including costs of imaging and surgical treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Compared to the \u2018gold standard\u2019 of ceCT, ceMRI was more effective but also more expensive, with a resulting incremental cost\u2010effectiveness ratio (ICER) &gt;\u20ac70\u00a0000 (Euro) per QALY gained. CEUS was dominant compared to ceCT in both Bosniak IIF and III renal cysts in terms of QALYs and costs. Probabilistic sensitivity analysis confirmed these results in the majority of iterations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Both ceMRI and CEUS can be used as alternatives to ceCT in the diagnosis and follow\u2010up of intermediately complex cystic renal lesions without compromising effectiveness, while CEUS is clearly cost\u2010effective. The economic results apply to a large university hospital and must be adapted for smaller hospitals.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/bju.15353","type":"journal-article","created":{"date-parts":[[2021,2,5]],"date-time":"2021-02-05T10:13:19Z","timestamp":1612519999000},"page":"575-585","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Cost\u2010effectiveness analysis of multiple imaging modalities in diagnosis and follow\u2010up of intermediate complex cystic renal lesions"],"prefix":"10.1111","volume":"128","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4016-9615","authenticated-orcid":false,"given":"Paul","family":"Spiesecke","sequence":"first","affiliation":[{"name":"Department of Radiology"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Reinhold","sequence":"additional","affiliation":[{"name":"Institute of Social Medicine, Epidemiology, and Health Economics"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yano","family":"Wehrenberg","sequence":"additional","affiliation":[{"name":"Institute of Controlling"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sven","family":"Werner","sequence":"additional","affiliation":[{"name":"Institute of Controlling"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6976-985X","authenticated-orcid":false,"given":"Andreas","family":"Maxeiner","sequence":"additional","affiliation":[{"name":"Department of Urology Charite\u0301 \u2013 Universit\u00e4tsmedizin Berlin, corporate member of Freie Universit\u00e4t Berlin, Humboldt\u2010Universit\u00e4t zu Berlin, and Berlin Institute of Health Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonas","family":"Busch","sequence":"additional","affiliation":[{"name":"Department of Urology Charite\u0301 \u2013 Universit\u00e4tsmedizin Berlin, corporate member of Freie Universit\u00e4t Berlin, Humboldt\u2010Universit\u00e4t zu Berlin, and Berlin Institute of Health Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Fischer","sequence":"additional","affiliation":[{"name":"Department of Radiology"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernd","family":"Hamm","sequence":"additional","affiliation":[{"name":"Department of Radiology"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1151-9935","authenticated-orcid":false,"given":"Markus Herbert","family":"Lerchbaumer","sequence":"additional","affiliation":[{"name":"Department of Radiology"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,3,18]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiology.158.1.3510019"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00330-016-4631-9"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2019182646"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.2214\/AJR.18.20415"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1177\/0284185118755575"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0155857"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.3310\/hta17090"},{"key":"e_1_2_8_9_1","article-title":"Comparison of magnetic resonance imaging and contrast\u2010enhanced ultrasound as diagnostic options for unclear cystic renal lesions: a cost\u2010effectiveness analysis","author":"Gassert F","year":"2020","journal-title":"Ultraschall Med"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacr.2020.09.010"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0009-9260(03)00165-X"},{"key":"e_1_2_8_12_1","first-page":"31","article-title":"The morphology of renal cystic disease","volume":"4","author":"Kissane JM","year":"1976","journal-title":"Perspect Nephrol Hypertens"},{"key":"e_1_2_8_13_1","unstructured":"Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft Deutsche Krebshilfe A).Diagnostik Therapie und Nachsorge des Nierenzellkarzinoms Langversion 1.2 2017 AWMF Registernummer: 043\/017OL [Internet]. 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