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Cost-effectiveness analysis of a non-contrast screening MRI protocol for vestibular schwannoma in patients with asymmetric sensorineural hearing loss

  • Diagnostic Neuroradiology
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Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusion

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.

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Acknowledgements

The authors would like to thank Duke Financial Services for providing charge data and interpretations.

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Authors and Affiliations

  1. Division of Otolaryngology-Head & Neck Surgery, Duke University Medical Center, 2301 Erwin Road, Durham, NC, 27710, USA

    Matthew G. Crowson, Daniel J. Rocke & David M. Kaylie

  2. Department of Radiology, Duke University Medical Center, Durham, NC, USA

    Jenny K. Hoang

  3. Professor Emerita of Diagnostic Radiology, Oregon Health Sciences University, Portland, OR, USA

    Jane L. Weissman

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  1. Matthew G. Crowson
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  2. Daniel J. Rocke
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Corresponding author

Correspondence to Matthew G. Crowson.

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No funding was received for this project.

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The authors declare that they have no conflict of interest.

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This article does not contain any studies with human participants performed by any of the authors.

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Crowson, M.G., Rocke, D.J., Hoang, J.K. et al. Cost-effectiveness analysis of a non-contrast screening MRI protocol for vestibular schwannoma in patients with asymmetric sensorineural hearing loss. Neuroradiology 59, 727–736 (2017). https://doi.org/10.1007/s00234-017-1859-2

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  • DOI: https://doi.org/10.1007/s00234-017-1859-2

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