Combined Use of 5-Aminolevulinic Acid and Intraoperative Low-Field Magnetic Resonance Imaging in High-Grade Glioma Surgery

Bassaganyas, Clara; Roldán, Pedro; González, Juan José; Ferrés, Abel; García, Sergio; Culebras, Diego; Hoyos, Jhon; Reyes, Luís; Torales, Jorge; Enseñat, Joaquim

doi:10.1016/j.wneu.2019.06.029

Cited by 8 publications

(10 citation statements)

References 24 publications

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“…Various reports have failed to demonstrate a significant improvement in OS in patients operated with the guidance of an intraoperative device despite higher GTR rates (13,20,25,28). One-year analysis showed a slight decline in the mortality rate found in the intervention group (15.75% vs. 12%).…”

Section: Discussionmentioning

confidence: 91%

“…Indeed, little has been said about the costs of these technologies, and even less about their cost-effectiveness and rationale for their implementation in public health systems (26). In previous publications, our group has highlighted the advantages and limitations of a low-field compared to a high-field iMR (13)(14)(15). Hence, in the current discussion, we will obviate differences regarding the novelty or technical specifications of the devices themselves.…”

Section: Discussionmentioning

confidence: 98%

“…Many groups have outlined the advantages of performing neurooncological surgery with the assistance of an iMR (13)(14)(15)20). Moreover, it has been consistently reported a variable but clear upward trend in the EoR of gliomas (13,15,(21)(22)(23). However, the vast majority of reports have failed to demonstrate A B FIGURE 3 | Monte Carlo simulations for the probabilistic sensitive analysis of cost-effectiveness results.…”

Section: Discussionmentioning

confidence: 99%

“…Patients operated with any other intraoperative image assistance or intraoperative fluorescence were excluded. The surgical workflow for the LF-iMR group has been previously described (13)(14)(15). Intraoperative neurophysiologic monitoring was implemented in both cohorts, according to the decision of the surgical team.…”

Section: Surgical Techniquementioning

confidence: 99%

“…Conversely, we inferred the cost per patient from all the indications in which we currently use the LF-iMR: intrinsic and extrinsic brain lesions, cavernomas, pituitary macroadenomas and epilepsy surgery. Thus, the cost of the device per patient was calculated considering a life cycle of 10 years and a potential number of 120 surgeries per year [50 oncological surgeries (13,15), 30 pituitary macroadenomas resection (14), 20 cavernous malformations resections, 20 epilepsy surgeries] ( Table 1).…”

Section: Cost-effectivenessmentioning

confidence: 99%

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Cost-Effectiveness of Low-Field Intraoperative Magnetic Resonance in Glioma Surgery

et al. 2020

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Low-field intraoperative magnetic resonance (LF-iMR) has demonstrated a slight increase in the extent of resection of intra-axial tumors while preserving patient`s neurological outcomes. However, whether this improvement is cost-effective or not is still matter of controversy. In this clinical investigation we sought to evaluate the costeffectiveness of the implementation of a LF-iMR in glioma surgery. Methods: Patients undergoing LF-iMR guided glioma surgery with gross total resection (GTR) intention were prospectively collected and compared to an historical cohort operated without this technology. Socio-demographic and clinical variables (pre and postoperative KPS; histopathological classification; Extent of resection; postoperative complications; need of re-intervention within the first year and 1-year postoperative survival) were collected and analyzed. Effectiveness variables were assessed in both groups: Postoperative Karnofsky performance status scale (pKPS); overall survival (OS); Progression-free survival (PFS); and a variable accounting for the number of patients with a greater than subtotal resection and same or higher postoperative KPS (R-KPS). All preoperative, procedural and postoperative costs linked to the treatment were considered for the cost-effectiveness analysis (diagnostic procedures, prosthesis, operating time, hospitalization, consumables, LF-iMR device, etc). Deterministic and probabilistic simulations were conducted to evaluate the consistency of our analysis. Results: 50 patients were operated with LF-iMR assistance, while 146 belonged to the control group. GTR rate, pKPS, R-KPS, PFS, and 1-year OS were respectively 13,8% (not significative), 7 points (p < 0.05), 17% (p < 0.05), 38 days (p < 0.05), and 3.7% (not significative) higher in the intervention group. Cost-effectiveness analysis showed a mean incremental cost per patient of 789 € in the intervention group. Incremental costeffectiveness ratios were 111 € per additional point of pKPS, 21 € per additional day free of progression, and 46 € per additional percentage point of R-KPS. Conclusion: Glioma patients operated under LF-iMR guidance experience a better functional outcome, higher resection rates, less complications, better PFS rates but

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Section: Discussionmentioning

confidence: 91%