Cost-effectiveness of Intraoperative MRI for Treatment of High-Grade Gliomas

Abstract

Background: Intraoperative MRI has been shown to improve gross-total resection of high-grade glioma. However, to the knowledge of the authors, the cost-effectiveness of intraoperative MRI has not been established. Purpose:To construct a clinical decision analysis model for assessing intraoperative MRI in the treatment of high-grade glioma. Materials and Methods:An integrated five-state microsimulation model was constructed to follow patients with high-grade glioma. Onehundred-thousand patients treated with intraoperative MRI were compared with 100 000 patients who were treated without intraoperative MRI from initial resection and debulking until death (median age at initial resection, 55 years). After the operation and treatment of complications, patients existed in one of three health states: progression-free survival (PFS), progressive disease, or dead. Patients with recurrence were offered up to two repeated resections. PFS, valuation of health states (utility values), probabilities, and costs were obtained from randomized controlled trials whenever possible. Otherwise, national databases, registries, and nonrandomized trials were used. Uncertainty in model inputs was assessed by using deterministic and probabilistic sensitivity analyses. A health care perspective was used for this analysis. A willingness-to-pay threshold of $100 000 per quality-adjusted life year (QALY) gained was used to determine cost efficacy.Results: Intraoperative MRI yielded an incremental benefit of 0.18 QALYs (1.34 QALYs with intraoperative MRI vs 1.16 QALYs without) at an incremental cost of $13 447 ($176 460 with intraoperative MRI vs $163 013 without) in microsimulation modeling, resulting in an incremental cost-effectiveness ratio of $76 442 per QALY. Because of parameter distributions, probabilistic sensitivity analysis demonstrated that intraoperative MRI had a 99.5% chance of cost-effectiveness at a willingness-to-pay threshold of $100 000 per QALY. Conclusion:Intraoperative MRI is likely to be a cost-effective modality in the treatment of high-grade glioma.

The Neurosurgeon’s Armamentarium for Gliomas: An Update on Intraoperative Technologies to Improve Extent of Resection

“…Additionally, iMRI has been found to increase the operative time by approximately one hour [ 84 ], which may potentially pose greater intraoperative risk to patients due to prolonged anesthesia time [ 85 ]. However, iMRI has been shown to be cost-effective in the treatment of HGG, showing an incremental benefit of 0.18 quality-adjusted life years (QALYs), making the argument for a wider adaptation of the technology [ 86 ].…”

Applying machine learning to optical coherence tomography images for automated tissue classification in brain metastases

“…Intraoperative imaging, such as intraoperative ultrasound (iUS) or intraoperative MRI (iMRI) are able to detect macroscopic tumor remnants with good sensitivity and specificity but are unable to discriminate tumor from healthy tissue on a submillimeter-level [11][12][13]. Also, the acquisition of MRI images is time-consuming and increases surgery time [14]. A fast imaging modality that can detect minimal tumor remnants could improve surgical outcome.…”

Resection and survival data from a clinical trial of glioblastoma multiforme‐specific IRDye800‐BBN fluorescence‐guided surgery

“…8 Damage to a functionally eloquent area can cause inevitable postoperative neurological deficits, including motor weakness, sensory deficits, language difficulties, and visual deficits. 9 During the past two decades, advanced neurosurgical imaging technologies, such as neuronavigation, 10,11 intraoperative ultrasonography (iUS), 12,13 and intraoperative magnetic resonance imaging (iMRI), 14,15 have been developed to achieve the maximum degree of tumor resection without incurring neurological deficits. Although these technologies have improved the potential to achieve a complete resection of GBM, all are associated with limitations and technical issues.…”