Is intraoperative ultrasound more efficient than magnetic resonance in neurosurgical oncology? An exploratory cost-effectiveness analysis
ObjectiveIntraoperative imaging is a chief asset in neurosurgical oncology, it improves the extent of resection and postoperative outcomes. Imaging devices have evolved considerably, in particular ultrasound (iUS) and magnetic resonance (iMR). Although iUS is regarded as a more economically convenie...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-10-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2022.1016264/full |
| _version_ | 1811197427914375168 |
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| author | Alejandra Mosteiro Alejandra Mosteiro Alberto Di Somma Alberto Di Somma Pedro Roldán Ramos Pedro Roldán Ramos Abel Ferrés Andrea De Rosa Sofía González-Ortiz Joaquim Enseñat Joaquim Enseñat Jose Juan González Jose Juan González |
| author_facet | Alejandra Mosteiro Alejandra Mosteiro Alberto Di Somma Alberto Di Somma Pedro Roldán Ramos Pedro Roldán Ramos Abel Ferrés Andrea De Rosa Sofía González-Ortiz Joaquim Enseñat Joaquim Enseñat Jose Juan González Jose Juan González |
| author_sort | Alejandra Mosteiro |
| collection | DOAJ |
| description | ObjectiveIntraoperative imaging is a chief asset in neurosurgical oncology, it improves the extent of resection and postoperative outcomes. Imaging devices have evolved considerably, in particular ultrasound (iUS) and magnetic resonance (iMR). Although iUS is regarded as a more economically convenient and yet effective asset, no formal comparison between the efficiency of iUS and iMR in neurosurgical oncology has been performed.MethodsA cost-effectiveness analysis comparing two single-center prospectively collected surgical cohorts, classified according to the intraoperative imaging used. iMR (2013-2016) and iUS (2021-2022) groups comprised low- and high-grade gliomas, with a maximal safe resection intention. Units of health gain were gross total resection and equal or increased Karnofsky performance status. Surgical and health costs were considered for analysis. The incremental cost-effectiveness ratio (ICER) was calculated for the two intervention alternatives. The cost-utility graphic and the evolution of surgical duration with the gained experience were also analyzed.Results50 patients followed an iMR-assisted operation, while 17 underwent an iUS-guided surgery. Gross total resection was achieved in 70% with iMR and in 60% with iUS. Median postoperative Karnofsky was similar in both group (KPS 90). Health costs were € 3,220 higher with iMR, and so were surgical-related costs (€ 1,976 higher). The ICER was € 322 per complete resection obtained with iMR, and € 644 per KPS gained or maintained with iMR. When only surgical-related costs were analyzed, ICER was € 198 per complete resection with iMR and € 395 per KPS gained or maintained.ConclusionThis is an unprecedented but preliminary cost-effectiveness analysis of the two most common intraoperative imaging devices in neurosurgical oncology. iMR, although being costlier and time-consuming, seems cost-effective in terms of complete resection rates and postoperative performance status. However, the differences between both techniques are small. Possibly, iMR and iUS are complementary aids during the resection: iUS real-time images assist while advancing towards the tumor limits, informing about the distance to relevant landmarks and correcting neuronavigation inaccuracy due to brain shift. Yet, at the end of resection, it is the iMR that reliably corroborates whether residual tumor remains. |
| first_indexed | 2024-04-12T01:14:39Z |
| format | Article |
| id | doaj.art-9cd9273e983247b3a002dee2811c56f0 |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-04-12T01:14:39Z |
| publishDate | 2022-10-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-9cd9273e983247b3a002dee2811c56f02022-12-22T03:54:01ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2022-10-011210.3389/fonc.2022.10162641016264Is intraoperative ultrasound more efficient than magnetic resonance in neurosurgical oncology? An exploratory cost-effectiveness analysisAlejandra Mosteiro0Alejandra Mosteiro1Alberto Di Somma2Alberto Di Somma3Pedro Roldán Ramos4Pedro Roldán Ramos5Abel Ferrés6Andrea De Rosa7Sofía González-Ortiz8Joaquim Enseñat9Joaquim Enseñat10Jose Juan González11Jose Juan González12Department of Neurosurgery, Hospital Clínic de Barcelona, Barcelona, SpainFacultad de Medicina, Universitat de Barcelona, Barcelona, SpainDepartment of Neurosurgery, Hospital Clínic de Barcelona, Barcelona, SpainFacultad de Medicina, Universitat de Barcelona, Barcelona, SpainDepartment of Neurosurgery, Hospital Clínic de Barcelona, Barcelona, SpainFacultad de Medicina, Universitat de Barcelona, Barcelona, SpainDepartment of Neurosurgery, Hospital Clínic de Barcelona, Barcelona, SpainDivision of Neurosurgery, Università degli Studi di Napoli “Federico II”, Naples, ItalyDivision of Neurosurgery, Università degli Studi di Napoli “Federico II”, Naples, ItalyDepartment of Neurosurgery, Hospital Clínic de Barcelona, Barcelona, SpainFacultad de Medicina, Universitat de Barcelona, Barcelona, SpainDepartment of Neurosurgery, Hospital Clínic de Barcelona, Barcelona, SpainFacultad de Medicina, Universitat de Barcelona, Barcelona, SpainObjectiveIntraoperative imaging is a chief asset in neurosurgical oncology, it improves the extent of resection and postoperative outcomes. Imaging devices have evolved considerably, in particular ultrasound (iUS) and magnetic resonance (iMR). Although iUS is regarded as a more economically convenient and yet effective asset, no formal comparison between the efficiency of iUS and iMR in neurosurgical oncology has been performed.MethodsA cost-effectiveness analysis comparing two single-center prospectively collected surgical cohorts, classified according to the intraoperative imaging used. iMR (2013-2016) and iUS (2021-2022) groups comprised low- and high-grade gliomas, with a maximal safe resection intention. Units of health gain were gross total resection and equal or increased Karnofsky performance status. Surgical and health costs were considered for analysis. The incremental cost-effectiveness ratio (ICER) was calculated for the two intervention alternatives. The cost-utility graphic and the evolution of surgical duration with the gained experience were also analyzed.Results50 patients followed an iMR-assisted operation, while 17 underwent an iUS-guided surgery. Gross total resection was achieved in 70% with iMR and in 60% with iUS. Median postoperative Karnofsky was similar in both group (KPS 90). Health costs were € 3,220 higher with iMR, and so were surgical-related costs (€ 1,976 higher). The ICER was € 322 per complete resection obtained with iMR, and € 644 per KPS gained or maintained with iMR. When only surgical-related costs were analyzed, ICER was € 198 per complete resection with iMR and € 395 per KPS gained or maintained.ConclusionThis is an unprecedented but preliminary cost-effectiveness analysis of the two most common intraoperative imaging devices in neurosurgical oncology. iMR, although being costlier and time-consuming, seems cost-effective in terms of complete resection rates and postoperative performance status. However, the differences between both techniques are small. Possibly, iMR and iUS are complementary aids during the resection: iUS real-time images assist while advancing towards the tumor limits, informing about the distance to relevant landmarks and correcting neuronavigation inaccuracy due to brain shift. Yet, at the end of resection, it is the iMR that reliably corroborates whether residual tumor remains.https://www.frontiersin.org/articles/10.3389/fonc.2022.1016264/fullintraoperative magnetic resonanceintraoperative ultrasoundneurosurgical oncologygliomacost-effectiveness |
| spellingShingle | Alejandra Mosteiro Alejandra Mosteiro Alberto Di Somma Alberto Di Somma Pedro Roldán Ramos Pedro Roldán Ramos Abel Ferrés Andrea De Rosa Sofía González-Ortiz Joaquim Enseñat Joaquim Enseñat Jose Juan González Jose Juan González Is intraoperative ultrasound more efficient than magnetic resonance in neurosurgical oncology? An exploratory cost-effectiveness analysis Frontiers in Oncology intraoperative magnetic resonance intraoperative ultrasound neurosurgical oncology glioma cost-effectiveness |
| title | Is intraoperative ultrasound more efficient than magnetic resonance in neurosurgical oncology? An exploratory cost-effectiveness analysis |
| title_full | Is intraoperative ultrasound more efficient than magnetic resonance in neurosurgical oncology? An exploratory cost-effectiveness analysis |
| title_fullStr | Is intraoperative ultrasound more efficient than magnetic resonance in neurosurgical oncology? An exploratory cost-effectiveness analysis |
| title_full_unstemmed | Is intraoperative ultrasound more efficient than magnetic resonance in neurosurgical oncology? An exploratory cost-effectiveness analysis |
| title_short | Is intraoperative ultrasound more efficient than magnetic resonance in neurosurgical oncology? An exploratory cost-effectiveness analysis |
| title_sort | is intraoperative ultrasound more efficient than magnetic resonance in neurosurgical oncology an exploratory cost effectiveness analysis |
| topic | intraoperative magnetic resonance intraoperative ultrasound neurosurgical oncology glioma cost-effectiveness |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2022.1016264/full |
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