Hojjat Houmehr, Svider Peter F, Davoodian Pedram, Hong Robert S, Folbe Adam J, Eloy Jean Anderson, A Shkoukani Mahdi
Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, U.S.A.
Michigan Ear Institute, Farmington Hills, Michigan, U.S.A.
Laryngoscope. 2017 Apr;127(4):939-944. doi: 10.1002/lary.26231. Epub 2016 Sep 30.
OBJECTIVES/HYPOTHESIS: Our objective was to perform an economic analysis evaluating whether ordering a magnetic resonance imaging (MRI) is a cost-effective practice in the workup of undifferentiated asymmetric sensorineural hearing loss (ASNHL). Use of T1 gadolinium-weighted MR (GdT1W) and T2 weighted MR without contrast (T2MR) was each examined.
The incremental cost-effectiveness ratio (ICER) of MR imaging among ASNHL patients was evaluated using a decision tree. We calculated what the probability of having a cerebellopontine angle/internal auditory canal lesion would have to be to make MR more cost-effective than observation. The decision pathways included observation, GdT1W, and T2MR. The probability of detecting a lesion and associated costs were employed in constructing our tree. Missing a mass in the observation branch was considered to have an effectiveness of 0. The costs and probabilities were extracted from previously published studies.
The ICERs of pursuing GdT1W and T2MR were $27,660 and $15,943, respectively, both below the widely accepted willingness to pay (WTP) thresholds of $30,000 and $50,000. Probabilistic sensitivity analysis with Monte Carlo simulations for GdT1W showed that it is more cost-effective than no imaging, with 54.4% and 83.5% certainty at $30,000 and $50,000 WTP thresholds. Probabilistic sensitivity analysis with Monte Carlo simulations for T2MR showed that it is more cost-effective than no imaging, with 75.2% and 92.6% certainty at $30,000 and $50,000 WTP thresholds.
This economic evaluation strongly supports pursuing MRI in patients with documented ASNHL as a cost-effective strategy. Both GdT1W and T2MR are more cost-effective than observation. Furthermore, noncontrast T2 imaging may be the more cost-effective modality of these two techniques.
2c. Laryngoscope, 127:939-944, 2017.
目的/假设：我们的目的是进行一项经济分析，评估在未分化的不对称感音神经性听力损失（ASNHL）的检查中，安排磁共振成像（MRI）检查是否具有成本效益。分别对使用钆加权T1磁共振成像（GdT1W）和无造影剂的T2加权磁共振成像（T2MR）进行了研究。
采用决策树评估ASNHL患者中磁共振成像的增量成本效益比（ICER）。我们计算了要使磁共振成像比观察更具成本效益，桥小脑角/内耳道病变的概率必须是多少。决策路径包括观察、GdT1W和T2MR。在构建我们的决策树时采用了检测病变的概率和相关成本。观察分支中漏诊肿块被认为有效性为0。成本和概率取自先前发表的研究。
采用GdT1W和T2MR的ICER分别为27,660美元和15,943美元，均低于广泛接受的支付意愿（WTP）阈值30,000美元和50,000美元。对GdT1W进行蒙特卡罗模拟的概率敏感性分析表明，它比不进行成像更具成本效益，在30,000美元和50,000美元的WTP阈值下，确定性分别为54.4%和83.5%。对T2MR进行蒙特卡罗模拟的概率敏感性分析表明，它比不进行成像更具成本效益，在30,000美元和50,000美元的WTP阈值下，确定性分别为75.2%和92.6%。
这项经济评估有力地支持了对已确诊的ASNHL患者进行MRI检查作为一种具有成本效益的策略。GdT1W和T2MR都比观察更具成本效益。此外，在这两种技术中，无造影剂的T2成像可能是更具成本效益的方式。
2c。《喉镜》，2017年，第127卷，第939 - 944页。
