Department of Radiology, NYU Langone Health, New York, New York, USA (S.G., M.D.S.C.); Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA (S.G.).
Department of Radiology, NYU Langone Health, New York, New York, USA (S.G., M.D.S.C.).
Acad Radiol. 2024 Jul;31(7):2880-2886. doi: 10.1016/j.acra.2024.01.019. Epub 2024 Jan 29.
To determine the most cost-effective strategy for pelvic bone marrow biopsies.
A decision analytic model from the health care system perspective for patients with high clinical concern for multiple myeloma (MM) was used to evaluate the incremental cost-effectiveness of three bone marrow core biopsy techniques: computed tomography (CT) guided, and fluoroscopy guided, no-imaging (landmark-based). Model input data on utilities, costs, and probabilities were obtained from comprehensive literature review and expert opinion. Costs were estimated in 2023 U.S. dollars. Primary effectiveness outcome was quality adjusted life years (QALY). Willingness to pay threshold was $100,000 per QALY gained.
No-imaging based biopsy was the most cost-effective strategy as it had the highest net monetary benefit ($4218) and lowest overall cost ($92.17). Fluoroscopy guided was excluded secondary to extended dominance. CT guided biopsies were less preferred as it had an incremental cost-effectiveness ratio ($334,043) greater than the willingness to pay threshold. Probabilistic sensitivity analysis found non-imaging based biopsy to be the most cost-effective in 100% of simulations and at all willingness to pay thresholds up to $200,000.
No-imaging based biopsy appears to be the most cost-effective strategy for bone marrow core biopsy in patients suspected of MM.
No imaging guidance is the preferred strategy, although image-guidance may be required for challenging anatomy. CT image interpretation may be helpful for planning biopsies. Establishing a non-imaging guided biopsy service with greater patient anxiety and pain support may be warranted.
确定骨盆骨髓活检最具成本效益的策略。
采用高临床疑似多发性骨髓瘤（MM）患者的医疗保健系统视角下的决策分析模型，评估三种骨髓核心活检技术的增量成本效益，即计算机断层扫描（CT）引导、透视引导和无影像（基于地标）引导。模型输入数据来自全面的文献回顾和专家意见，包括效用、成本和概率。成本以 2023 年美元估计。主要有效性结果是质量调整生命年（QALY）。意愿支付阈值为每获得一个 QALY 支付 100,000 美元。
无影像引导活检是最具成本效益的策略，因为它具有最高的净货币收益（4218 美元）和最低的总成本（92.17 美元）。透视引导被排除在外，因为它存在扩展优势。CT 引导活检不太受欢迎，因为其增量成本效益比（334,043 美元）超过了意愿支付阈值。概率敏感性分析发现，在 100%的模拟和所有意愿支付阈值下，无影像引导活检都是最具成本效益的，最高可达 200,000 美元。
无影像引导活检似乎是疑似 MM 患者骨髓核心活检最具成本效益的策略。
无影像引导是首选策略，尽管对于具有挑战性的解剖结构可能需要影像引导。CT 图像解释可能有助于规划活检。可能需要建立一个具有更大患者焦虑和疼痛支持的无影像引导活检服务。
