Year: 2018
Type: conference-abstract
Abstract: OBJECT: High-grade gliomas (HGGs) have poor survival and high treatment costs. Intraoperative MRI (ioMRI) improves gross-total resection (GTR) rates and prolongs progression-free survival (PFS) in HGGs, but questions regarding its cost-effectiveness persist. To date, no clinical decision analysis models assessing ioMRI in the treatment of HGG exist. An integrated 5-state microsimulation model was constructed to follow patients with HGG. Patients treated with ioMRI were compared to those without ioMRI from initial resection/debulking until death. Following surgery and treatment of complications, patients existed in one of 3 health states: PFS, progressive disease, or dead. Patients with recurrence were offered up to two repeat resections. PFS, health utility values, probabilities, and costs were obtained from randomized-controlled trials whenever possible. Otherwise, national databases, registries, and non-randomized trials were used. Uncertainty in model inputs was assessed using deterministic and probabilistic sensitivity analyses. A healthcare perspective was taken for this analysis. A willingness to pay (WTP) threshold of $100,000/QALY gained was used to determine cost-efficacy. IoMRI yielded an incremental benefit of 0.18 QALYs (1.16 QALYs without ioMRI vs. 1.34 with) at an incremental cost of $13,447 ($157,000 without vs. $170,447 with) in microsimulation modeling, resulting in an incremental cost-effectiveness ratio (ICER) of $76,442 per QALY. Given our parameter distributions, probabilistic sensitivity analysis demonstrated that ioMRI had a 99.5% chance of cost-effectiveness at a WTP threshold of $100,000/QALY. Intra-operative MRI is likely a cost-effective modality in the treatment of HGGs.
Source: Neuro-Oncology
Institution: University of California San Diego
Language: English
Subfield: Economics and Econometrics
Domain: Social Sciences
Open Access status: bronze
OpenAlex ID: W2899533225