{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T02:44:27Z","timestamp":1782787467857,"version":"3.54.5"},"reference-count":40,"publisher":"Wiley","issue":"S1","license":[{"start":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T00:00:00Z","timestamp":1769040000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T00:00:00Z","timestamp":1769040000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["bjui-journals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJU International"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To determine whether\u00a0current intraoperative margin assessment (IOMA) techniques (such as Neurovascular Structure Adjacent Frozen\u2010section Examination [NeuroSAFE] or confocal laser microscopy [CLM]) used during radical prostatectomy (RP) to enhance nerve\u2010sparing surgery (NSS) while reducing positive surgical margins (PSMs) justify their extra costs, this study assessed their cost\u2010effectiveness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A decision analytical model assessed health outcomes and costs associated with NeuroSAFE and CLM (using the Histolog\u00ae Scanner) compared to bilateral, unilateral, and non\u2010NSS. Outcomes were calculated in quality\u2010adjusted life years (QALYs), with a cost\u2010effectiveness threshold of \u20ac50\u2009000 per QALY. NSS reduced erectile dysfunction and incontinence probabilities. However, when extraprostatic extension was present but not identified pre\u2010 or intraoperatively, NSS resulted in a PSM, increasing the risk of biochemical recurrence (BCR) and development of metastases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The NeuroSAFE and CLM were cost\u2010effective strategies compared to non\u2010IOMA strategies. NeuroSAFE was most cost\u2010effective if NeuroSAFE and CLM were used in an equal number of patients. However, if NeuroSAFE was used in &gt;8% fewer patients compared to CLM, CLM was most cost\u2010effective. Sensitivity analyses highlighted the impact of PSMs on cost\u2010effectiveness. In hospitals with higher RP volumes (&gt;160 per year), CLM had lower costs per procedure than NeuroSAFE.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Intraoperative margin assessment during RP is a cost\u2010effective intervention. The choice to implement NeuroSAFE or CLM should be guided by both surgical volume and available capacity, as the more labour\u2010intensive nature of NeuroSAFE may limit its use and reduces its cost\u2010effectiveness compared with CLM.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/bju.70121","type":"journal-article","created":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T11:04:03Z","timestamp":1769079843000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The cost\u2010effectiveness of intraoperative margin assessment strategies during radical prostatectomy"],"prefix":"10.1111","volume":"138","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-4920-3772","authenticated-orcid":false,"given":"Joost","family":"van Drumpt","sequence":"first","affiliation":[{"name":"Department of Urology Canisius Wilhelmina Hospital  Nijmegen The Netherlands"},{"name":"Prosper Prostate Cancer Clinics  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