Please use this identifier to cite or link to this item:
Title: Cost-Effectiveness of Low-Field Intraoperative Magnetic Resonance in Glioma Surgery
Author: García García, Sergio
García Lorenzo, Borja
Roldán Ramos, Pedro
González Sánchez, José Juan
Culebras, Diego
Restovic, Gabriela
Alcover, Estanis
Pons, Imma
Torales, Jorge
Reyes, Luis
Sampietro Colom, Laura
Enseñat Nora, Joaquim
Keywords: Glioma
Ressonància magnètica
Magnetic resonance
Issue Date: 2-Nov-2020
Publisher: Frontiers Media
Abstract: Object: 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 cost-effectiveness 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 cost-effectiveness 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 similar life expectancy compared to conventional techniques. In terms of efficiency, LF-iMR is very close to be a dominant technology in terms of R-KPS, PFS and pKPS.
Note: Reproducció del document publicat a:
It is part of: Frontiers In Oncology, 2020, vol. 10
Related resource:
ISSN: 2234-943X
Appears in Collections:Articles publicats en revistes (Cirurgia i Especialitats Medicoquirúrgiques)

Files in This Item:
File Description SizeFormat 
708227.pdf1.28 MBAdobe PDFView/Open

This item is licensed under a Creative Commons License Creative Commons