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December 1, 2020 — Ultraschall in der Medizin – European Journal of Ultrasound



Accurate 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 (< 1.5 cm) 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.


A decision model based on Markov simulations estimated lifetime costs and quality-adjusted life years (QALYs) associated with unenhanced ultrasound and CEUS. Model 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 $100 000/QALY.


In 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.


Contrast-enhanced ultrasound is a cost-effective imaging method for the characterization of nonpalpable testicular lesions.

Authors: Johannes Rübenthaler1, Su Hwan Kim1, Wolfgang G. Kunz1, Wieland H. Sommer1, Matthias Trottmann2, Dirk-André Clevert1, Matthias Frank Froelich3

1  Department of Radiology, Interdisciplinary ultrasound-center, University-Hospital LMU Munich, Germany; 2  Department of Urology, University of Munich, Germany; 3  Institute of Clinical Radiology and Nuclear Medicine, University Medical Centre Mannheim, Germany

Read full text at: Ultraschall Med 2020; 41(06): 668-674

DOI: 10.1055/a-1010-5955;    Issue 06 · Volume 41

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