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Auditory brainstem response prior to MRI compared to standalone MRI in the detection of vestibular schwannoma: a modelling study
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  • Stan Wijn,
  • Mayke Hentschel,
  • Andy Beynon,
  • Henricus Kunst,
  • Maroeska Rovers
Stan Wijn
Radboudumc
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Mayke Hentschel
Radboudumc
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Andy Beynon
Radboudumc
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Henricus Kunst
Radboudumc
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Maroeska Rovers
Radboudumc
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Abstract

Objectives: To determine the cost-effectiveness of auditory brainstem response prior to MRI (ABR-MRI) compared to standalone MRI to diagnose vestibular schwannoma. Design: A state transition decision-analytic model was developed to simulate costs and effects (quality-adjusted life years) for both treatment strategies for patients suspected of a vestibular schwannoma. Model input was derived from literature, hospital databases, and expert opinions. Scenario and sensitivity analyses addressed model uncertainty. Results: Over a lifetime horizon, ABR-MRI resulted in a limited cost-saving of \euro68 or \euro98 per patient (dependent on MRI sequence) and a health loss of 0.005 QALYs over standalone MRI. ABR-MRI, however, did miss patients with other important pathology (2% of the population) that would have been detected when using standalone MRI. Calculating the incremental cost-effectiveness ratio resulted in \euro14,203 or \euro19,550 saved per lost QALY if ABR-MRI was used instead of standalone MRI. The results were sensitive to the detection rate of vestibular schwannoma and health-related quality of life of missed patients. Conclusion: The cost-saving with ABR-MRI does not seem to outweigh the number of missed patients with VS and other important pathologies that would have been detected when using standalone MRI.

Peer review status:IN REVISION

07 Jun 2021Submitted to Clinical Otolaryngology
28 Jun 2021Assigned to Editor
28 Jun 2021Submission Checks Completed
17 Jul 2021Reviewer(s) Assigned
05 Oct 2021Review(s) Completed, Editorial Evaluation Pending
10 Oct 2021Editorial Decision: Revise Minor