1 Mallinckrodt Institute of Radiology, Washington University School of Medicine, Campus Box 8131, 510 S Kingshighway Blvd, St. Louis, MO 63110.
AJR Am J Roentgenol. 2014 Jan;202(1):136-44. doi: 10.2214/AJR.13.10610.
The objective of our study was to compare the cost-effectiveness of two approaches to using MRI for the evaluation of patients with hearing loss.
We developed a decision tree to compare the cost-effectiveness of conventional MRI with that of a proposed two-tiered model in which an initial 3D T2-weighted imaging examination was used to determine the need for comprehensive MR scanning. Three radiologists independently and blindly reviewed the 3D T2-weighted images acquired as part of the comprehensive MR examinations of 256 patients with hearing loss to assess the diagnostic efficacy of the two-tiered approach. Costs were defined in terms of both the scanner utilization time for the imaging facility and the dollar amount for payers. Effectiveness was defined in terms of the ability to correctly detect the presence or absence of disease.
The conventional approach was less cost-effective, with a baseline incremental cost-effectiveness ratio (ICER) of 27,299 minutes of scanner utilization per unit increase in effectiveness. Assuming a 50% reduction in the reimbursement of the technical component from the current level by the Centers for Medicare & Medicaid Services, this result reflected an ICER of $258,664 per unit increase in effectiveness. The results of a sensitivity analysis showed the robustness of the cost-effectiveness of the two-tiered imaging approach in a variety of scenarios that reflect differences in scanning practices and possible differences in recall rates. The conventional imaging approach was absolutely dominated by the two-tiered approach in the scenarios created to reflect the expected range of prevalence of disease.
A two-tiered approach to MRI provides a more cost-effective alternative to the current approach of using a comprehensive MRI examination without and with contrast material to evaluate patients with hearing loss.
我们的研究目的是比较两种使用 MRI 评估听力损失患者的方法的成本效益。
我们构建了一个决策树，以比较常规 MRI 与提出的两层模型的成本效益，其中初始的 3D T2 加权成像检查用于确定是否需要全面的磁共振扫描。三位放射科医生独立并盲法地审查了 256 例听力损失患者全面 MR 检查中获得的 3D T2 加权图像，以评估两层方法的诊断效果。成本根据成像设施的扫描仪使用时间和支付方的美元金额来定义。有效性根据正确检测疾病存在或不存在的能力来定义。
常规方法的成本效益较低，其基线增量成本效益比（ICER）为每增加一个单位的有效性，扫描仪利用时间增加 27299 分钟。假设医疗保险和医疗补助服务中心（Centers for Medicare & Medicaid Services）将技术部分的报销降低 50%，则该结果反映了每增加一个单位有效性的 ICER 为 258664 美元。敏感性分析的结果表明，在反映扫描实践差异和可能的召回率差异的各种情况下，两层成像方法的成本效益具有稳健性。在为反映预期疾病流行率范围而创建的场景中，常规成像方法完全被两层成像方法所主导。
与目前使用全面 MRI 检查（有无对比剂）评估听力损失患者的方法相比，MRI 的两层方法提供了一种更具成本效益的替代方法。
