Potential savings in the diagnosis of vestibular schwannoma

Abstract

Introduction Magnetic resonance imaging (MRI) is used to screen patients at risk for vestibular schwannoma (VS). These MRIs are costly and have an extremely low yield; only 3% of patients in the screening population has an actual VS. It might be worthwhile to develop a test to predict VS and refer only a subset of all patients for MRI. Objective To examine the potential savings of such a hypothetical diagnostic test before MRI. Design We built a decision analytical model of the diagnostic strategy of VS. Input was derived from literature and key opinion leaders. The current strategy was compared to hypothetical new strategies, assigning MRI to the following: (i) all patients with pathology, (ii) all patients with important pathology and (iii) only patients with VS. This resulted in potential cost savings for each strategy. We conducted a budget impact analysis to predict nationwide savings for the Netherlands and the United Kingdom (UK), and a probabilistic sensitivity analysis to address uncertainty. Results Mean savings ranged from €256 (95%CI €250 ‐ €262) or approximately US$284 (95%CI US$277 ‐ US$291) per patient for strategy 1 to €293 (95%CI €290 ‐ €296) or approximately US$325 (95%CI US$322 ‐ US$328) per patient for strategy 3. Future diagnostic strategies can cost up to these amounts per patient and still be cost saving. Annually, for the Netherlands, €2.8 to €3.2 million could be saved and €10.8 to €12.3 million for the UK. Conclusions The model shows that substantial savings could be generated if it is possible to further optimise the diagnosis of VS.

Subclinical vestibular dysfunction in migraineurs without vertigo: A Clinical study

“…All participants underwent a full bedside and instrumental vestibular examination with the following tests [17][18][19][20][21][22] to exclude the presence of balance and/ or vestibular disorders, such as, for example, benign paroxysmal po- In particular, spontaneous and positional nystagmus were observed; the induced nystagmus was observed by infrared videonystagmography (VNG): the main parameter took into consideration was the angular velocity of the slow phase during culmination phase (from 60 seconds to 90 seconds since the beginning of the stimulation). All participants underwent a full bedside and instrumental vestibular examination with the following tests [17][18][19][20][21][22] to exclude the presence of balance and/ or vestibular disorders, such as, for example, benign paroxysmal po- In particular, spontaneous and positional nystagmus were observed; the induced nystagmus was observed by infrared videonystagmography (VNG): the main parameter took into consideration was the angular velocity of the slow phase during culmination phase (from 60 seconds to 90 seconds since the beginning of the stimulation).…”

“…The study was performed in blind and the physician who performed the vestibular examination was one for all patients. All participants underwent a full bedside and instrumental vestibular examination with the following tests [17][18][19][20][21][22] to exclude the presence of balance and/ or vestibular disorders, such as, for example, benign paroxysmal po- In particular, spontaneous and positional nystagmus were observed; the induced nystagmus was observed by infrared videonystagmography (VNG): the main parameter took into consideration was the angular velocity of the slow phase during culmination phase (from 60 seconds to 90 seconds since the beginning of the stimulation). VNG is a non-invasive test, designed to document the ability to follow visual objects with eyes and how well the eyes respond to information from the vestibular system.…”

Nystagmus Based Screening System for Vestibular Schwannoma in Patients With Asymmetric Hearing Loss

“…Moreover, the report that only 3% of asymmetric sensorineural hearing loss (ASNHL) patients who receive MRI are diagnosed to VS raises a question about the practicality of MRI. 4) Since the late 1970s, the efficacy of auditory brainstem re-sponse (ABR) has been supported by many studies. Koors, et al 5) have performed a meta-analysis of ABR in VS and calculated that the average sensitivity of ABR is 93.4% with an average specificity of 82%, supporting that ABR is a useful diagnostic tool for patients with clinically suspected VS.…”

Development of a diagnostic model to identify patients at high risk for cerebellopontine angle lesions

“…If all MRIs without VS could be avoided, approximately €293 (or US$347, including price of consultation following MRI) could be saved per patient with AAD [ 4 , 5 ]. In the Netherlands (17.3 million inhabitants) [ 6 ], this could result in potential savings of up to €3.2 million per year [ 7 ]. It, therefore, seems worthwhile to investigate new diagnostic strategies to preselect patients with a high risk of a CPA lesion for MRI.…”