Auditory brainstem response prior to MRI compared to standalone MRI in the detection of vestibular schwannoma: A modelling study

• Published in: Clinical otolaryngology Vol. 47; no. 2; pp. 295 - 303
• Main Authors: Wijn, Stan R. W., Hentschel, Mayke A., Beynon, Andy J., Kunst, Henricus P. M., Rovers, Maroeska M.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.03.2022; John Wiley and Sons Inc
• Subjects: auditory brainstem response; Brain stem; Cost-Benefit Analysis; cost‐effectiveness analysis; diagnostic; Evoked Potentials, Auditory, Brain Stem; Humans; Magnetic resonance imaging; Magnetic Resonance Imaging - economics; Neuroma, Acoustic - diagnosis; Original; Patients; Quality of life; Schwann cells; Sensitivity analysis; vestibular schwannoma; Vestibular system; auditory brainstem response; magnetic resonance imaging; diagnostic; cost-effectiveness analysis; vestibular schwannoma
• ISSN: 1749-4478; 1749-4486
• DOI: 10.1111/coa.13894

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 model was developed to simulate costs and effects (quality‐adjusted life years [QALY]) for both diagnostic 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 €68 or €98 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. In total, €14 203 or €19 550 could be 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.