Activity-Based Cost Analysis of Including Contrast-Enhanced Ultrasound (CEUS) in the Diagnostic Pathway of Focal Pancreatic Lesions Detected by Abdominal Ultrasound

Abstract

Purpose To perform an activity-based cost analysis of the inclusion of contrast-enhanced ultrasound (CEUS) in the diagnostic pathway of newly detected focal pancreatic lesions revealed by abdominal ultrasound (US) in comparison to computed tomography (CT) and magnetic resonance imaging (MRI).

Materials and Methods Over a 14-year period, 977 patients with newly detected focal pancreatic lesions on US and subsequently studied with CEUS and/or CT and MRI were included. The cost of equipment, materials and human resources for every imaging method was calculated. We analyzed the costs in different scenarios considering whether or not CT or MRI was required in the diagnostic pathway. The savings (R) were calculated by subtracting the differential cost of CEUS from the eliminated third-level exam (CCEUS: CEUS cost; CCT: CT cost; CMRI: MRI cost) compared to conventional ultrasound (CCEUS-CUS): R = CCT-(CCEUS-CUS) or R = CMRI-(CCEUS-CUS).

Results Total costs were: US 28.39 €; CEUS 70.50 €; CT 106.23 €; MRI 219.61 €. In 388/563 patients CEUS characterized the pancreatic lesion as solid, with only CT being performed as a second-level investigation: the savings were 68 870.36 €. In 266/414 patients CEUS diagnosed lesions as cystic, with only MRI being performed as a second-level examination: the savings were 16 825.07 €. Considering the whole diagnostic pathway of the patients, the cost savings were 76 809.35 € for solid lesions and 26 242.49 € for cystic lesions, with overall savings of 103 051.84 €.

Conclusion CEUS represents a cost-effective imaging method for the differentiation of focal pancreatic lesions and could guide the selection of the best imaging modality for preoperative assessment, thereby optimizing resources and securing the diagnostic pathway.

Zusammenfassung

Ziel Durchführung einer prozessorientierten Kostenanalyse bei Einschluss von kontrastverstärktem Ultraschall (CEUS) im Vergleich zur Computertomografie (CT) und Magnetresonanztomografie (MRT) auf dem Weg zur Diagnose bei neu entdeckten fokalen Pankreasläsionen im abdominalen Ultraschall (US).

Material und Methoden Über einen Zeitraum von 14 Jahren wurden 977 Patienten mit neu im US entdeckten fokalen Pankreasläsionen aufgenommen und anschließend mittels CEUS und/oder CT und MRI untersucht. Die Kosten für Ausrüstung, Material und Personal wurden für jede Bildgebungsmethode berechnet (CCEUS: CEUS cost; CCT: CT cost; CMRI: MRI cost). Wir haben die Kosten in verschiedenen Szenarien analysiert, um zu untersuchen, ob die Diagnose CT oder MRI erforderlich waren oder nicht. Die Einsparung (R) wurde berechnet, indem die Kostendifferenz von CEUS im Vergleich zum herkömmlichen US (CCEUS-CUS) von der Untersuchung der dritten Stufe abgezogen wurde: R = CCT-(CCEUS-CUS) oder R = CMRI-(CCEUS-CUS).

Ergebnisse Die Gesamtkosten betrugen für US 28,39 €, CEUS 70,50 €, CT 106,23 € und MRT 219,61 €. Bei 388/563 Patienten charakterisierte CEUS die Pankreasläsion als solide und bei Durchführung eines CT als einzige Zweituntersuchung betrug die Ersparnis 68 870,36 €. Bei 266/414 Patienten diagnostizierte CEUS die Läsionen als zystisch und bei Durchführung einer MRT als einzige Zweituntersuchung betrug die Ersparnis 16 825,07 €. In Anbetracht des Gesamtwegs zur Diagnose der Patienten betrug die Kostenersparnis bei soliden Läsionen 76 809,35 € und bei zystischen Läsionen 26 242,49 €, mit einer Gesamtersparnis von 103 051,84 €.

Schlussfolgerung CEUS ist ein kostengünstiges bildgebendes Verfahren zur Differenzierung von fokalen Pankreasläsionen und kann dazu beitragen, die beste Bildgebung für eine präoperative Beurteilung zu wählen, die Ressourcen zu optimieren und die Diagnosestellung zu sichern.

Key words

pancreas - activity-based cost analysis - CEUS

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