Tim Van den Wyngaert1,2, Swetha R Palli3, Ryan J Imhoff3, Michael T Hirschmann4,5. 1. Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium tim.van.den.wyngaert@uza.be. 2. Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium. 3. CTI Clinical Trial and Consulting Services, Covington, Kentucky. 4. Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Bruderholz, Switzerland; and. 5. University of Basel, Basel, Switzerland.
Abstract
The purpose of this study was to quantify the economic value of bone SPECT/CT versus CT or metal artifact reduction sequence (MARS)-MRI for the diagnostic assessment of recurrent moderate-to-severe pain after total knee arthroplasty (TKA). Methods: An Excel-based simulation model was developed to compare bone SPECT/CT versus CT or MARS-MRI from a payer perspective. Clinical endpoints (diagnosis-delayed or otherwise, and the subsequent treatment and complications) and their corresponding cost data (2017 U.S. dollars) were obtained by performing a best evidence review of the published literature. Studies were pooled and parameters weighted by sample size. A cost-utility analysis was performed estimating the incremental cost per quality-adjusted life years gained between bone SPECT/CT and the comparative scans. One-way (±25%) sensitivity analysis was performed to gauge the model robustness. Results: For every 1,000 TKA patients, diagnostic bone SPECT/CT was expected to lead to 3-y cost savings up to $1,867,695 versus CT (or $622.6 per patient per year) and $1,723,435 versus MARS-MRI (or $574.5 per patient per year) for a payer. With corresponding incremental quality-adjusted life years gains of 39.7 and 41.0 against CT and MARS-MRI, SPECT/CT can be considered as a cost-saving and dominant strategy in the workup of persistent/recurrent pain in TKA patients. The model was limited by the still sparse literature data, was most sensitive to imaging-related sensitivity/specificity, but proved robust for varying prevalence of surgical/nonsurgical causes of pain. Conclusion: Bone SPECT/CT is a potentially highly cost-saving and dominant imaging intervention versus CT or MARS-MR scanning in patients with recurrent and persistent knee pain after TKA.
The purpose of this study was to quantify the economic value of bone SPECT/CT versus CT or metal artifact reduction sequence (MARS)-MRI for the diagnostic assessment of recurrent moderate-to-severe pain after total knee arthroplasty (TKA). Methods: An Excel-based simulation model was developed to compare bone SPECT/CT versus CT or MARS-MRI from a payer perspective. Clinical endpoints (diagnosis-delayed or otherwise, and the subsequent treatment and complications) and their corresponding cost data (2017 U.S. dollars) were obtained by performing a best evidence review of the published literature. Studies were pooled and parameters weighted by sample size. A cost-utility analysis was performed estimating the incremental cost per quality-adjusted life years gained between bone SPECT/CT and the comparative scans. One-way (±25%) sensitivity analysis was performed to gauge the model robustness. Results: For every 1,000 TKA patients, diagnostic bone SPECT/CT was expected to lead to 3-y cost savings up to $1,867,695 versus CT (or $622.6 per patient per year) and $1,723,435 versus MARS-MRI (or $574.5 per patient per year) for a payer. With corresponding incremental quality-adjusted life years gains of 39.7 and 41.0 against CT and MARS-MRI, SPECT/CT can be considered as a cost-saving and dominant strategy in the workup of persistent/recurrent pain in TKA patients. The model was limited by the still sparse literature data, was most sensitive to imaging-related sensitivity/specificity, but proved robust for varying prevalence of surgical/nonsurgical causes of pain. Conclusion: Bone SPECT/CT is a potentially highly cost-saving and dominant imaging intervention versus CT or MARS-MR scanning in patients with recurrent and persistent knee pain after TKA.
Authors: Femke F Schröder; Corine E Post; Frank-Christiaan B M Wagenaar; Nico Verdonschot; Rianne M H A Huis In't Veld Journal: J Magn Reson Imaging Date: 2019-07-22 Impact factor: 4.813
Authors: Harry Hothi; Arianna Cerquiglini; Lukas Büel; Johann Henckel; Lukas B Moser; Michael T Hirschmann; Alister Hart Journal: Tomography Date: 2022-01-07