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- Title
To image or not to image? A cost-effectiveness analysis of MRI for patients with asymmetric sensorineural hearing loss.
- Authors
Hojjat, Houmehr; Svider, Peter F.; Davoodian, Pedram; Hong, Robert S.; Folbe, Adam J.; Eloy, Jean Anderson; A. Shkoukani, Mahdi
- Abstract
<bold>Objectives/hypothesis: </bold>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.<bold>Methods: </bold>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.<bold>Results: </bold>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.<bold>Conclusion: </bold>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.<bold>Level Of Evidence: </bold>2c. Laryngoscope, 127:939-944, 2017.
- Subjects
SENSORINEURAL hearing loss; MEDICAL records; MEDICAL care; SICK people; AUDITORY neurons; BIOACOUSTICS
- Publication
Laryngoscope, 2017, Vol 127, Issue 4, p939
- ISSN
0023-852X
- Publication type
journal article
- DOI
10.1002/lary.26231