Grech Fonk Lorna, Ferreira Teresa A, Webb Andrew G, Luyten Gregorius P M, Beenakker Jan-Willem M
Department of Ophthalmology, Leiden University Medical Centre, Leiden, the Netherlands.
Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands.
Clin Ophthalmol. 2020 Apr 28;14:1135-1143. doi: 10.2147/OPTH.S238405. eCollection 2020.
Uveal melanoma (UM) is the most common primary intra-ocular tumour. Treatment is determined by tumour size and location. Generally, smaller tumours are eligible for brachytherapy unless they are located close to posterior pole. Larger tumours are enucleated or undergo proton beam therapy (PBT), which is more expensive than brachytherapy and less available. Accuracy of tumour size determination is critical for accurate planning and delivery of treatment, particularly to ensure tumour coverage, critical structure sparing, and for the choice of treatment modality. This is particularly the case for tumour dimensions that are close to the cut-off point for a specific type of treatment: in the case of the brachytherapy protocol at our institution, 6-8 mm. Ultrasound is conventionally used, but magnetic resonance imaging (MRI) has recently become an additional available tool. Although more expensive, it enables more accurate measurements and is particularly useful in combination with clinical fundus examination, fundus photography and ultrasound. Our aim in this paper was to determine the economic value of MRI for UM treatment.
We retrospectively analysed 60 patients' MRI scans acquired as part of a study or for clinical care. For each patient, we assessed whether the extra cost of an MRI generated economic benefit or change in optimal treatment.
MRI indicated a smaller tumour prominence than US in 10% of patients with intermediate tumour size, resulting in a change from PBT to brachytherapy. The costs of MRI, €200-€1000, are significantly lower than the higher costs of PBT compared to brachytherapy, €24,000 difference. In addition, the annual total economic burden of severe vision impairment associated with eye removal is €10,000. Furthermore, for patients where ultrasound was impossible due to previous surgery, MRI enabled eye-preserving treatment.
An additional MRI for specific patients with UM improves economic value as it enables less expensive treatment in a sufficient percentage of patients to compensate for the MRI costs. Value is increased in terms of quality of care as it enables for some a treatment option which spares more vision.
葡萄膜黑色素瘤（UM）是最常见的原发性眼内肿瘤。治疗方案取决于肿瘤的大小和位置。一般来说，较小的肿瘤适合近距离放射治疗，除非它们靠近后极部。较大的肿瘤则需进行眼球摘除术或质子束治疗（PBT），质子束治疗比近距离放射治疗费用更高且可及性更低。准确确定肿瘤大小对于精确的治疗计划和实施至关重要，特别是要确保肿瘤覆盖范围、保护关键结构以及选择治疗方式。对于接近特定治疗类型临界点的肿瘤尺寸来说尤其如此：在我们机构的近距离放射治疗方案中，这个临界点是6 - 8毫米。传统上使用超声检查，但磁共振成像（MRI）最近已成为另一种可用工具。尽管MRI费用更高，但它能进行更精确的测量，并且与临床眼底检查、眼底摄影和超声检查结合使用时特别有用。本文的目的是确定MRI在UM治疗中的经济价值。
我们回顾性分析了60例患者作为研究一部分或临床护理所获取的MRI扫描图像。对于每位患者，我们评估了MRI的额外费用是否产生了经济效益或导致最佳治疗方案的改变。
在10%中等肿瘤大小的患者中，MRI显示的肿瘤突出程度比超声检查小，从而使治疗方案从质子束治疗改为近距离放射治疗。MRI的费用为200 - 1000欧元，与近距离放射治疗相比，质子束治疗的较高费用为24000欧元，两者差异显著。此外，与眼球摘除相关的严重视力损害的年度总经济负担为10000欧元。此外，对于因先前手术而无法进行超声检查的患者，MRI使保眼治疗成为可能。
为特定的UM患者额外进行MRI检查可提高经济价值，因为它能使相当比例的患者接受费用较低的治疗，从而弥补MRI的成本。在医疗质量方面价值也有所提升，因为它使一些患者能够选择更能保留视力的治疗方案。
