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Cost analysis of vestibular schwannoma screening with contrast-enhanced magnetic resonance imaging in patients with asymmetrical hearing loss

Published online by Cambridge University Press:  14 September 2015

P Pan ,
J Huang ,
C Morioka ,
G Hathout  and
S M El-Saden
P Pan*
Affiliation:
Department of Radiology, UCLA Medical Center, Los Angeles, California, USA
J Huang
Affiliation:
Department of Radiology, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
C Morioka
Affiliation:
Department of Radiology, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
G Hathout
Affiliation:
Department of Radiology, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
S M El-Saden
Affiliation:
Department of Radiology, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
*
Address for correspondence: Dr Patrick Pan, Department of Radiology, UCLA Medical Center, 757 Westwood Blvd, Los Angeles, CA 90095, USA E-mail: ppan@mednet.ucla.edu
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Abstract

Background:

Vestibular schwannomas are a rare cause of asymmetrical hearing loss, and routine screening with magnetic resonance imaging can be costly. This paper reports results on vestibular schwannoma screening at our institution and compares the cost of screening to a utility of hearing benefit.

Method:

All screening examinations with magnetic resonance imaging performed for asymmetrical hearing loss between 2006 and 2011 were retrospectively reviewed. The cost per new vestibular schwannoma diagnosis was calculated. The cost per patient for those who benefitted from intervention was estimated based on rates of hearing preservation reported in the literature.

Results:

Forty-five (4.3 per cent) of 1050 screening examinations with magnetic resonance imaging performed for asymmetrical hearing loss were positive for vestibular schwannoma, and the cost per new diagnosis was $11 436. The estimated screening cost per patient for those who benefitted from surgery or radiation was $147 030, while US federal compensation for unilateral hearing loss was $44 888.

Conclusion:

Although we achieved a lower screening cost per new diagnosis than reported in the current literature, there remains disparity between the screening cost per benefitted patient and the ‘benefit’ of hearing.

Keywords

Vestibular SchwannomaScreeningMagnetic Resonance ImagingHearing LossCost Analysis
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 130 , Issue 1 , January 2016 , pp. 21 - 24
Copyright
Copyright © JLO (1984) Limited 2015 

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References

1Urben, SL, Benninger, MS, Gibbens, ND. Asymmetric sensorineural hearing loss in a community-based population. Otolaryngol Head Neck Surg 1999;120:809–14CrossRefGoogle Scholar
2Dawes, P, Jeannon, J-P. Audit of regional screening guidelines for vestibular schwannoma. J Laryngol Otol 1998;112:860–4CrossRefGoogle ScholarPubMed
3Wilson, YL, Gandolfi, MM, Ahn, IE, Yu, G, Huang, TC, Kim, AH. Cost analysis of asymmetric sensorineural hearing loss investigations. Laryngoscope 2010;120:1832–6CrossRefGoogle ScholarPubMed
4Zygourakis, CC, Oh, T, Sun, MZ, Barani, I, Kahn, JG, Parsa, AT. Surgery is cost-effective treatment for young patients with vestibular schwannomas: decision tree modeling of surgery, radiation, and observation. Neurosurg Focus 2014;37:E8CrossRefGoogle ScholarPubMed
5Lunsford, LD, Niranjan, A, Flickinger, JC, Maitz, A, Kondziolka, D. Radiosurgery of vestibular schwannomas: summary of experience in 829 cases. J Neurosurg 2013;119:24–8Google Scholar
6Prasad, D, Steiner, M, Steiner, L. Gamma surgery for vestibular schwannoma. J Neurosurg 2000;92:745–59CrossRefGoogle ScholarPubMed
7Samii, M, Gerganov, V, Samii, A. Improved preservation of hearing and facial nerve function in vestibular schwannoma surgery via the retrosigmoid approach in a series of 200 patients. J Neurosurg 2006;105:527–35CrossRefGoogle Scholar
8Rupa, V, Job, A, George, M, Rajshekhar, V. Cost-effective initial screening for vestibular schwannoma: auditory brainstem response or magnetic resonance imaging? Otolaryngol Head Neck Surg 2003;128:823–8Google ScholarPubMed
9Saliba, I, Martineau, G, Chagnon, M. Asymmetric hearing loss: rule 3,000 for screening vestibular schwannoma. Otol Neurotol 2009;30:515–21CrossRefGoogle Scholar
10Kotlarz, JP, Eby, TL, Borton, TE. Analysis of the efficiency of retrocochlear screening. Laryngoscope 1992;102:1108–12CrossRefGoogle ScholarPubMed
11Allen, RW, Harnsberger, HR, Shelton, C, King, B, Bell, DA, Miller, R et al. Low-cost high-resolution fast spin-echo MR of acoustic schwannoma: an alternative to enhanced conventional spin-echo MR? AJNR Am J Neuroradiol 1996;17:1205–10Google ScholarPubMed
12Stuckey, SL, Harris, AJ, Mannolini, SM. Detection of acoustic schwannoma: use of constructive interference in the steady state three-dimensional MR. AJNR Am J Neuroradiol 1996;17:1219–25Google ScholarPubMed
13Fukui, MB, Weissman, JL, Curtin, HD, Kanal, E. T2-weighted MR characteristics of internal auditory canal masses. AJNR Am J Neuroradiol 1996;17:1211–18Google ScholarPubMed
14Daniels, RL, Shelton, C, Harnsberger, HR. Ultra high resolution nonenhanced fast spin echo magnetic resonance imaging: cost-effective screening for acoustic neuroma in patients with sudden sensorineural hearing loss. Otolaryngol Head Neck Surg 1998;119:364–9CrossRefGoogle ScholarPubMed
15Saeed, S, Woolford, T, Ramsden, R, Lye, R. Magnetic resonance imaging: a cost-effective first line investigation in the detection of vestibular schwannomas. Br J Neurosurg 1995;9:497–503CrossRefGoogle ScholarPubMed
16Zealley, I, Cooper, R, Clifford, K, Campbell, R, Potterton, A, Zammit-Maempel, I et al. MRI screening for acoustic neuroma: a comparison of fast spin echo and contrast enhanced imaging in 1233 patients. Br J Radiol 2000;73:242–7CrossRefGoogle ScholarPubMed
17Cunningham, H, Maynard, D, Bontcheva, K, Tablan, V, Aswani, N, Roberts, I et al. Text Processing with GATE (Version 6). Sheffield: GATE, 2011;15Google Scholar
18Hajioff, D, Raut, V, Walsh, R, Bath, A, Bance, M, Guha, A et al. Conservative management of vestibular schwannomas: third review of a 10-year prospective study. Clin Otolaryngol 2008;33:255–9CrossRefGoogle ScholarPubMed
19Centers for Medicare and Medicaid Services. Physician Fee Schedule. In: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/ [16 May 2015]Google Scholar
20Social Security Administration. National Average Wage Index. In: http://www.ssa.gov/oact/cola/AWI.html [16 May 2015]Google Scholar
21Samii, M, Matthies, C. Management of 1000 vestibular schwannomas (acoustic neuromas): hearing function in 1000 tumor resections. Neurosurgery 1997;40:248–62CrossRefGoogle ScholarPubMed
22Flickinger, JC, Kondziolka, D, Niranjan, A, Lunsford, LD. Results of acoustic neuroma radiosurgery: an analysis of 5 years' experience using current methods. J Neurosurg 2001;94:1–6CrossRefGoogle ScholarPubMed
23Glasscock, ME 3rd, Hays, JW, Minor, LB, Haynes, DS, Carrasco, VN. Preservation of hearing in surgery for acoustic neuromas. J Neurosurg 1993;78:864–70CrossRefGoogle Scholar
24Karpinos, M, Teh, BS, Zeck, O, Carpenter, LS, Phan, C, Mai, W-Y et al. Treatment of acoustic neuroma: stereotactic radiosurgery vs. microsurgery. Int J Radiat Oncol Biol Phys 2002;54:1410–21CrossRefGoogle ScholarPubMed
25Propp, JM, McCarthy, BJ, Davis, FG, Preston-Martin, S. Descriptive epidemiology of vestibular schwannomas. Neuro Oncol 2006;8:1–11CrossRefGoogle ScholarPubMed
26Stangerup, S-E, Tos, M, Caye-Thomasen, P, Tos, T, Klokker, M, Thomsen, J. Increasing annual incidence of vestibular schwannoma and age at diagnosis. J Laryngol Otol 2004;118:622–7CrossRefGoogle ScholarPubMed
27Bakkouri, WE, Kania, RE, Guichard, J-P, Lot, G, Herman, P, Huy, PT. Conservative management of 386 cases of unilateral vestibular schwannoma: tumor growth and consequences for treatment. J Neurosurg 2009;110:662–9CrossRefGoogle ScholarPubMed
28Gormley, WB, Sekhar, LN, Wright, DC, Kamerer, D, Schessel, D. Acoustic neuromas: results of current surgical management. Neurosurgery 1997;41:50–60CrossRefGoogle ScholarPubMed
29Forster, DM, Kemeny, AA, Pathak, A, Walton, L. Radiosurgery: a minimally interventional alternative to microsurgery in the management of acoustic neuroma. Br J Neurosurg 1996;10:169–74Google ScholarPubMed
30Martin, HC, Sethi, J, Lang, D, Neil-Dwyer, G, Lutman, ME, Yardley, L. Patient-assessed outcomes after excision of acoustic neuroma: postoperative symptoms and quality of life. J Neurosurg 2001;94:211–16CrossRefGoogle ScholarPubMed