Is intraoperative ultrasound more efficient than magnetic resonance in neurosurgical oncology? An exploratory cost-effectiveness analysis.
Is intraoperative ultrasound more efficient than magnetic resonance in neurosurgical oncology? An exploratory cost-effectiveness analysis.
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DOI：
10.3389/fonc.2022.1016264
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发表时间：
2022
影响因子：
4.7
通讯作者：
Juan Gonzalez, Jose
中科院分区：
文献类型：
--
作者：
Mosteiro, Alejandra;Di Somma, Alberto;Roldan Ramos, Pedro;Ferres, Abel;De Rosa, Andrea;Gonzalez-Ortiz, Sofia;Ensenat, Joaquim;Juan Gonzalez, Jose
关键词：
术中成像是神经外科肿瘤学的一项重要资产，它改善了手术切除的范围和术后的预后。成像设备已经有了相当大的发展，特别是超声(IUS)和磁共振(IMR)。尽管IUS被认为是一种更经济、更方便、更有效的资产，但在神经外科肿瘤学中，IUS和IMR的有效性还没有进行正式的比较。一项成本-效果分析，比较两个单中心前瞻性收集的手术队列，根据术中使用的影像进行分类。IMR(2013-2016)和IUS(2021-2022)组包括低级别和高级别胶质瘤，具有最大的安全切除意图。健康收益的单位是大体全切除和等于或增加卡诺夫斯基状态。手术和医疗费用被考虑用于分析。计算两种干预方案的增量成本-效果比(ICER)。还分析了成本效用图和手术持续时间随经验的演变。50名患者接受了IMR辅助手术，17名患者接受了IUS引导手术。IMR和IUS的大体全切除率分别为70%和60%。两组术后Karnofsky评分中位数相似(KPS-90)。使用IMR后，医疗费用增加了3220欧元，与手术相关的费用也增加了1976欧元。IMR获得的完整切除的ICER为322欧元，IMR获得或维持的每KPS的ICER为644欧元。当仅分析与手术相关的费用时，ICER为每完整切除加IMR 198欧元，每获得或维持每KPS 395欧元。这是对神经外科肿瘤学中两种最常见的术中成像设备进行的一项史无前例但初步的成本效益分析。IMR虽然更昂贵、更耗时，但在完全切除率和术后表现状态方面似乎具有成本效益。然而，这两种技术之间的差异很小。在切除过程中，IMR和IUS可能是互补的辅助工具：IUS实时图像在向肿瘤边界推进时提供帮助，告知到相关地标的距离，并纠正由于大脑移位而导致的神经导航不准确。然而，在切除结束时，IMR才能可靠地证实是否残留肿瘤。
Intraoperative 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. A 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. 50 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. This 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.
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影响因子：
2.4
作者：
Moiyadi, Aliasgar V.;Shetty, Prakash M.;Sridhar, Epari
通讯作者：
Sridhar, Epari
影响因子：
4.7
作者：
Garcia-Garcia S;García-Lorenzo B;Ramos PR;Gonzalez-Sanchez JJ;Culebras D;Restovic G;Alcover E;Pons I;Torales J;Reyes L;Sampietro-Colom L;Enseñat J
通讯作者：
Enseñat J
DOI：
10.1055/s-0035-1551830
发表时间：
2016-03-01
影响因子：
1
作者：
Incekara, Fatih;Olubiyi, Olutayo;Golby, Alexandra
通讯作者：
Golby, Alexandra
影响因子：
4.8
作者：
Mohammadi, Alireza Mohammad;Sullivan, T. Barrett;Vogelbaum, Michael A.
通讯作者：
Vogelbaum, Michael A.
影响因子：
2
作者：
Familiari, Pietro;Frati, Alessandro;Raco, Antonino
通讯作者：
Raco, Antonino