Crowson Matthew G, Rocke Daniel J, Hoang Jenny K, Weissman Jane L, Kaylie David M
Division of Otolaryngology-Head & Neck Surgery, Duke University Medical Center, 2301 Erwin Road, Durham, NC, 27710, USA.
Department of Radiology, Duke University Medical Center, Durham, NC, USA.
Neuroradiology. 2017 Aug;59(8):727-736. doi: 10.1007/s00234-017-1859-2. Epub 2017 Jun 16.
We aimed to determine if a non-contrast screening MRI is cost-effective compared to a full MRI protocol with contrast for the evaluation of vestibular schwannomas.
A decision tree was constructed to evaluate full MRI and screening MRI strategies for patients with asymmetric sensorineural hearing loss. If a patient were to have a positive screening MRI, s/he received a full MRI. Vestibular schwannoma prevalence, MRI specificity and sensitivity, and gadolinium anaphylaxis incidence were obtained through literature review. Institutional charge data were obtained using representative patient cohorts. One-way and probabilistic sensitivity analyses were completed to determine CE model threshold points for MRI performance characteristics and charges.
The mean charge for a full MRI with contrast was significantly higher than a screening MRI ($4089 ± 1086 versus $2872 ± 741; p < 0.05). The screening MRI protocol was more cost-effective than a full MRI protocol with a willingness-to-pay from $0 to 20,000 USD. Sensitivity analyses determined that the screening protocol dominated when the screening MRI charge was less than $4678, and the imaging specificity exceeded 78.2%. The screening MRI protocol also dominated when vestibular schwannoma prevalence was varied between 0 and 1000 in 10,000 people.
A screening MRI protocol is more cost-effective than a full MRI with contrast in the diagnostic evaluation of a vestibular schwannoma. A screening MRI likely also confers benefits of shorter exam time and no contrast use. Further investigation is needed to confirm the relative performance of screening protocols for vestibular schwannomas.
我们旨在确定与用于评估前庭神经鞘瘤的含造影剂的完整MRI方案相比，非增强筛查MRI是否具有成本效益。
构建决策树以评估不对称感音神经性听力损失患者的完整MRI和筛查MRI策略。如果患者筛查MRI呈阳性，则接受完整MRI检查。通过文献综述获得前庭神经鞘瘤患病率、MRI特异性和敏感性以及钆过敏反应发生率。使用具有代表性的患者队列获得机构收费数据。完成单向和概率敏感性分析，以确定MRI性能特征和费用的成本效益模型阈值点。
含造影剂的完整MRI的平均费用显著高于筛查MRI（4089±1086美元对2872±741美元；p<0.05）。筛查MRI方案比完整MRI方案更具成本效益，支付意愿为0至20,000美元。敏感性分析确定，当筛查MRI费用低于4678美元且成像特异性超过78.2%时，筛查方案占主导地位。当10000人中前庭神经鞘瘤患病率在0至1000之间变化时，筛查MRI方案也占主导地位。
在诊断评估前庭神经鞘瘤时，筛查MRI方案比含造影剂的完整MRI更具成本效益。筛查MRI可能还具有检查时间短和无需使用造影剂的优点。需要进一步研究以确认前庭神经鞘瘤筛查方案的相对性能。
