ArticleBJU international2026
The cost-effectiveness of intraoperative margin assessment strategies during radical prostatectomy.
Article in BJU international, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
1 citing paper in PubMed.
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Authors and funding
8 authors.
Funding
Abstract
objectiveTo determine whether current intraoperative margin assessment (IOMA) techniques (such as Neurovascular Structure Adjacent Frozen-section Examination [NeuroSAFE] or confocal laser microscopy [CLM]) used during radical prostatectomy (RP) to enhance nerve-sparing surgery (NSS) while reducing positive surgical margins (PSMs) justify their extra costs, this study assessed their cost-effectiveness.
methodsA decision analytical model assessed health outcomes and costs associated with NeuroSAFE and CLM (using the Histolog® Scanner) compared to bilateral, unilateral, and non-NSS. Outcomes were calculated in quality-adjusted life years (QALYs), with a cost-effectiveness threshold of €50 000 per QALY. NSS reduced erectile dysfunction and incontinence probabilities. However, when extraprostatic extension was present but not identified pre- or intraoperatively, NSS resulted in a PSM, increasing the risk of biochemical recurrence (BCR) and development of metastases.
resultsThe NeuroSAFE and CLM were cost-effective strategies compared to non-IOMA strategies. NeuroSAFE was most cost-effective if NeuroSAFE and CLM were used in an equal number of patients. However, if NeuroSAFE was used in >8% fewer patients compared to CLM, CLM was most cost-effective. Sensitivity analyses highlighted the impact of PSMs on cost-effectiveness. In hospitals with higher RP volumes (>160 per year), CLM had lower costs per procedure than NeuroSAFE.
conclusionsIntraoperative margin assessment during RP is a cost-effective intervention. The choice to implement NeuroSAFE or CLM should be guided by both surgical volume and available capacity, as the more labour-intensive nature of NeuroSAFE may limit its use and reduces its cost-effectiveness compared with CLM.
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