Scholte M, et al. – Magnetic resonance imaging (MRI) was costly and had an extremely low yield in the diagnosis of vestibular schwannoma (VS). Therefore, the experts of this study intended to establish a test to predict VS, and refer only a subset of all patients for MRI. Their developed model demonstrated that substantial savings could be generated if it was possible to further optimise the diagnosis of VS.

Methods

• A decision analytical model of the diagnostic strategy of VS was designed.
• From literature and key opinion leaders, input was derived.
• The current strategy was compared to hypothetical new strategies, assigning MRI to:
  • All patients with pathology
  • All patients with important pathology
  • Only patients with VS.
• This resulted in potential cost savings for each strategy.
• A budget impact analysis was performed to predict nationwide savings for the Netherlands and the United Kingdom (UK).
• A probabilistic sensitivity analysis was conducted to address uncertainty.

Results

• Mean savings ranged from €256 (95%CI €250 – €262) or approximately US$284 (95%CI US$277 – US$291) per patient for strategy 1 to €293 (95%CI €290 – €296) or approximately US$325 (95%CI US$322 – US$328) per patient for strategy 3.
• Future diagnostic strategies can cost up to these amounts per patient and still be cost saving.
• Annually, for the Netherlands €2.8 to €3.2 million could be saved and €10.8 to €12.3 million for the UK.