Cost-effectiveness of neuromuscular ultrasound in focal neuropathies

Abstract

ObjectiveTo evaluate the cost-effectiveness of neuromuscular ultrasound (NMUS) for the evaluation of focal neuropathies.MethodsA prior prospective, randomized, double-blind controlled trial demonstrated that NMUS, when added to electrodiagnostic testing, resulted in improved clinical outcomes after 6 months of follow-up. From this study, we abstracted quality-adjusted life-years (QALYs) from the 36-item Short Form Health Survey and entered this health-utility estimate into a mixed trial and model-based cost-effectiveness analysis from the societal perspective. Costs of intervention (NMUS) were estimated from Medicare payment rates for Current Procedural Terminology codes. Health care use was otherwise estimated to be equal, but sensitivity analyses further examined this and other key assumptions. Incremental cost-effectiveness ratio (ICER) was used as the primary outcome with a willingness-to-pay threshold of $50,000 per QALY.ResultsThe predicted mean health outcome associated with use of NMUS was 0.079 QALY, and the mean cost was $37, resulting in an ICER of $463 per QALY. Results and conclusions remained robust across all sensitivity analyses, including variations in time horizon, initial distribution of health states, costs, and effectiveness.ConclusionsFrom a societal perspective, the addition of NMUS to electrodiagnostic testing when evaluating a focal neuropathy is cost-effective. A study of longer follow-up incorporating total health care use would further quantify the value of NMUS.ClinicalTrials.gov identifier:NCT01394822.

Current and future applications of ultrasound imaging in peripheral nerve disorders

“…Recent developments in technology have begun to reduce the financial strain associated with US unit purchase, with more economical laptop-based units and US integrated into EMG machines providing adequate resolution for the evaluation of nerves in most regions of interest. Once equipped, NMUS in mononeuropathy cohorts is reported to improve quality of life outcomes, with only modest outlays on cost-effectiveness analyses[ 267 , 268 ]. While these initial studies suggest a positive benefit-outlay ratio, the overall cost-effectiveness of NMUS for diagnostics, monitoring and prognostication in neuromuscular diseases is not yet known.…”

“Why don't you have a look?” The value of incorporating neuromuscular ultrasound in routine clinical practice

“…Apart from its increased diagnostic yield, the improved cost‐effectiveness of neuromuscular ultrasound cannot be ignored, especially when it concerns a large group of patients such as those with entrapment mononeuropathies 9 . One recent study showed that the addition of ultrasound in focal neuropathies is efficient from a American societal perspective, with a cost of $463 for each quality‐adjusted life‐year gained 10 . When it comes to treatment of mononeuropathies, ultrasound guidance of corticosteroid injections adds value as well 11 …”

Pride and precision: Personalizing care in diagnostic neurology laboratories

“…No such evidence currently exists. Furthermore, it should be noted that not only is diagnostic neuromuscular ultrasound painless, but it cost‐effectively improves outcomes 14,18 …”

“…Furthermore, it should be noted that not only is diagnostic neuromuscular ultrasound painless, but it costeffectively improves outcomes. 14,18 What then, is the role of EDX tests, other than median nerve conduction studies, in CTS? In patients with diabetes or findings suggestive of polyneuropathy, experience suggests that additional distal nerve conduction studies may help grade electrophysiologic severity of polyneuropathy and the interpretation of median motor and sensory studies.…”