Ross Mandeville1, Arvin Wali2, Charlie Park2, Erik Groessl2, Francis O Walker2, Michael S Cartwright2. 1. From the Department of Neuroscience (R.M.), School of Medicine (A.W., C.P.), and Department of Family Medicine and Public Health (E.G.), University of California, San Diego; and Department of Neurology (F.O.W., M.S.C.), Wake Forest School of Medicine, Winston-Salem, NC. rmandeville@ucsd.edu. 2. From the Department of Neuroscience (R.M.), School of Medicine (A.W., C.P.), and Department of Family Medicine and Public Health (E.G.), University of California, San Diego; and Department of Neurology (F.O.W., M.S.C.), Wake Forest School of Medicine, Winston-Salem, NC.
Abstract
OBJECTIVE: To evaluate the cost-effectiveness of neuromuscular ultrasound (NMUS) for the evaluation of focal neuropathies. METHODS: A prior prospective, randomized, double-blind controlled trial demonstrated that NMUS, when added to electrodiagnostic testing, resulted in improved clinical outcomes after 6 months of follow-up. From this study, we abstracted quality-adjusted life-years (QALYs) from the 36-item Short Form Health Survey and entered this health-utility estimate into a mixed trial and model-based cost-effectiveness analysis from the societal perspective. Costs of intervention (NMUS) were estimated from Medicare payment rates for Current Procedural Terminology codes. Health care use was otherwise estimated to be equal, but sensitivity analyses further examined this and other key assumptions. Incremental cost-effectiveness ratio (ICER) was used as the primary outcome with a willingness-to-pay threshold of $50,000 per QALY. RESULTS: The predicted mean health outcome associated with use of NMUS was 0.079 QALY, and the mean cost was $37, resulting in an ICER of $463 per QALY. Results and conclusions remained robust across all sensitivity analyses, including variations in time horizon, initial distribution of health states, costs, and effectiveness. CONCLUSIONS: From a societal perspective, the addition of NMUS to electrodiagnostic testing when evaluating a focal neuropathy is cost-effective. A study of longer follow-up incorporating total health care use would further quantify the value of NMUS. CLINICALTRIALSGOV IDENTIFIER: NCT01394822.
RCT Entities:
OBJECTIVE: To evaluate the cost-effectiveness of neuromuscular ultrasound (NMUS) for the evaluation of focal neuropathies. METHODS: A prior prospective, randomized, double-blind controlled trial demonstrated that NMUS, when added to electrodiagnostic testing, resulted in improved clinical outcomes after 6 months of follow-up. From this study, we abstracted quality-adjusted life-years (QALYs) from the 36-item Short Form Health Survey and entered this health-utility estimate into a mixed trial and model-based cost-effectiveness analysis from the societal perspective. Costs of intervention (NMUS) were estimated from Medicare payment rates for Current Procedural Terminology codes. Health care use was otherwise estimated to be equal, but sensitivity analyses further examined this and other key assumptions. Incremental cost-effectiveness ratio (ICER) was used as the primary outcome with a willingness-to-pay threshold of $50,000 per QALY. RESULTS: The predicted mean health outcome associated with use of NMUS was 0.079 QALY, and the mean cost was $37, resulting in an ICER of $463 per QALY. Results and conclusions remained robust across all sensitivity analyses, including variations in time horizon, initial distribution of health states, costs, and effectiveness. CONCLUSIONS: From a societal perspective, the addition of NMUS to electrodiagnostic testing when evaluating a focal neuropathy is cost-effective. A study of longer follow-up incorporating total health care use would further quantify the value of NMUS. CLINICALTRIALSGOV IDENTIFIER: NCT01394822.
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