Cost‐effectiveness analysis of multiple imaging modalities in diagnosis and follow‐up of intermediate complex cystic renal lesions

Objectives: To compare health-economic 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-up by either contrast-enhanced computed tomography (ceCT), contrast-enhanced magnetic resonance imaging (ceMRI), or contrast-enhanced ultrasonography (CEUS). Patients and methods: A simulation using Markov models was implemented and performed with 10 cycles of 1 year 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-adjusted life years (QALY), and costs as averages per patient including costs of imaging and surgical treatment. Results: Compared to the 'gold standard' of ceCT, ceMRI was more effective but also more expensive, with a resulting incremental cost-effectiveness ratio (ICER) >€70 000 (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. Conclusion: Both ceMRI and CEUS can be used as alternatives to ceCT in the diagnosis and follow-up of intermediately complex cystic renal lesions without compromising effectiveness, while CEUS is clearly cost-effective. The economic results apply to a large university hospital and must be adapted for smaller hospitals

The Embodied and Situated Nature of Moods

This is the final version of the article. Available from Springer via the DOI in this record.In this paper I argue that it is misleading to regard the brain as the physical basis or “core machinery” of moods. First, empirical evidence shows that brain activity not only influences, but is in turn influenced by, physical activity taking place in other parts of the organism (such as the endocrine and immune systems). It is therefore not clear why the core machinery of moods ought to be restricted to the brain. I propose, instead, that moods should be conceived as embodied, i.e., their physical basis should be enlarged so as to comprise not just brain but also bodily processes. Second, I emphasise that moods are also situated in the world. By this I do not simply mean that moods are influenced by the world, but that they are complexly interrelated with it, in at least three different ways: they are shaped by cultural values and norms; they are materially and intersubjectively “scaffolded”; and they can even “experientially incorporate” parts of the world, i.e., include the experience of parts of the world as part of oneself