Using Cost-Effectiveness Analysis to Measure Value in Musculoskeletal Imaging

Visser, Jacob J.; Oei, Edwin H.G.; Hunink, M. G. Myriam

doi:10.1055/s-0036-1597254

Cited by 3 publications

(3 citation statements)

References 25 publications

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“…Multidisciplinary conferences provide an excellent opportunity to demonstrate value added to patient care, and there is growing research on this topic [4, 9, 10, 16, 23, 29, 30]. The time cost of radiology input for a multidisciplinary orthopaedic oncology conference was USD 24,310 USD per annum in this study.…”

Section: Discussionmentioning

confidence: 91%

What is the Value of Radiology Input During a Multidisciplinary Orthopaedic Oncology Conference?

Komarraju

Rilland

Gebhardt

et al. 2023

Clin Orthop Relat Res

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Background Multidisciplinary orthopaedic oncology conferences are important in developing the treatment plan for patients with suspected orthopaedic bone and soft tissue tumors, involving physicians from several services. Past studies have shown the clinical value of these conferences; however, the impact of radiology input on the management plan and time cost for radiology to staff these conferences has not been fully studied. Questions/purposes (1) Does radiology input at multidisciplinary conference help guide clinical management and improve clinician confidence? (2) What is the time cost of radiology input for a multidisciplinary conference? Methods This prospective study was conducted from October 2020 to March 2022 at a tertiary academic center with a sarcoma center. A single data questionnaire for each patient was sent to one of three treating orthopaedic oncologists with 41, 19, and 5 years of experience after radiology discussion at a weekly multidisciplinary conference. A data questionnaire was completed by the treating orthopaedic oncologist for 48% (322 of 672) of patients, which refers to the proportion of those three oncologists’ patients for which survey data were captured. A musculoskeletal radiology fellow and musculoskeletal fellowship–trained radiology attending physician provided radiology input at each multidisciplinary conference. The clinical plan (leave alone, follow-up imaging, follow-up clinically, recommend different imaging test, core needle biopsy, surgical excision or biopsy or fixation, or other) and change in clinical confidence before and after radiology input were documented. A second weekly data questionnaire was sent to the radiology fellow to estimate the time cost of radiology input for the multidisciplinary conference. Results In 29% (93 of 322) of patients, there was a change in the clinical plan after radiology input. Biopsy was canceled in 30% (24 of 80) of patients for whom biopsy was initially planned, and surgical excision was canceled in 24% (17 of 72) of patients in whom surgical excision was initially planned. In 21% (68 of 322) of patients, there were unreported imaging findings that affected clinical management; 13% (43 of 322) of patients had a missed finding, and 8% (25 of 322) of patients had imaging findings that were interpreted incorrectly. For confidence in the final treatment plan, 78% (251 of 322) of patients had an increase in clinical confidence by their treating orthopaedic oncologist after the multidisciplinary conference. Radiology fellows and attendings spent a mean of 4.2 and 1.5 hours, respectively, reviewing and presenting at a multidisciplinary conference each week. The annual combined prorated time cost for the radiology attending and fellow was estimated at USD 24,310 based on national median salary data for attendings and internal salary data for fellows. Conclusion In a study taken at one tertiary-care oncology program, input from radiology attendings and fellows in the setting of a multidisciplinary conference helped to guide the final treatment plan, reduce procedures, and improve clinician confidence in the final treatment plan, at an annual time cost of USD 24,310. Clinical Relevance Multidisciplinary orthopaedic oncology conferences can lead to changes in management plans, and the time cost to the radiologists should be budgeted for by the radiology department or parent institution.

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Section: Discussionmentioning

confidence: 91%

What is the Value of Radiology Input During a Multidisciplinary Orthopaedic Oncology Conference?

Komarraju

Rilland

Gebhardt

et al. 2023

Clin Orthop Relat Res

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“…Due to privacy regulations, the examiner and future parents are not depicted in this photo. The photo was used for publication with consent of examiner and future parents Preferably, before implementing a new modality in daily clinical practice, cost-effectiveness should be considered [28]. Cost-effectiveness may be studied from several perspectives [29].…”

Section: Introductionmentioning

confidence: 99%

“…The diagnostic yield of the 3D VR will be compared with international guidelines and literature. Preferably, before implementing a new modality in daily clinical practice, cost-effectiveness should be considered [ 28 ]. Cost-effectiveness may be studied from several perspectives [ 29 ].…”

Section: Introductionmentioning

confidence: 99%

First trimester anomaly scan using virtual reality (VR FETUS study): study protocol for a randomized clinical trial

Pietersma

Mulders

Moolenaar

et al. 2020

BMC Pregnancy Childbirth

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Background In recent years it has become clear that fetal anomalies can already be detected at the end of the first trimester of pregnancy by two-dimensional (2D) ultrasound. This is why increasingly in developed countries the first trimester anomaly scan is being offered as part of standard care. We have developed a Virtual Reality (VR) approach to improve the diagnostic abilities of 2D ultrasound. Three-dimensional (3D) ultrasound datasets are used in VR assessment, enabling real depth perception and unique interaction. The aim of this study is to investigate whether first trimester 3D VR ultrasound is of additional value in terms of diagnostic accuracy for the detection of fetal anomalies. Health-related quality of life, cost-effectiveness and also the perspective of both patient and ultrasonographer on the 3D VR modality will be studied. Methods Women in the first trimester of a high risk pregnancy for a fetus with a congenital anomaly are eligible for inclusion. This is a randomized controlled trial with two intervention arms. The control group receives ‘care as usual’: a second trimester 2D advanced ultrasound examination. The intervention group will undergo an additional first trimester 2D and 3D VR ultrasound examination. Following each examination participants will fill in validated questionnaires evaluating their quality of life and healthcare related expenses. Participants’ and ultrasonographers’ perspectives on the 3D VR ultrasound will be surveyed. The primary outcome will be the detection of fetal anomalies. The additional first trimester 3D VR ultrasound examination will be compared to ‘care as usual’. Neonatal or histopathological examinations are considered the gold standard for the detection of congenital anomalies. To reach statistical significance and 80% power with a detection rate of 65% for second trimester ultrasound examination and 70% for the combined detection of first trimester 3D VR and second trimester ultrasound examination, a sample size of 2800 participants is needed. Discussion First trimester 3D VR detection of fetal anomalies may improve patients’ quality of life through reassurance or earlier identification of malformations. Results of this study will provide policymakers and healthcare professionals with the highest level of evidence for cost-effectiveness of first trimester ultrasound using a 3D VR approach. Trial registration Dutch Trial Registration number NTR6309, date of registration 26 January 2017.

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Cost-effectiveness Analysis in Diagnostic Musculoskeletal Radiology: A Systematic Review

Daggett

Cantarelli

Gyftopoulos

et al. 2023

Current Problems in Diagnostic Radiology

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Using Cost-Effectiveness Analysis to Measure Value in Musculoskeletal Imaging

Cited by 3 publications

References 25 publications

What is the Value of Radiology Input During a Multidisciplinary Orthopaedic Oncology Conference?

What is the Value of Radiology Input During a Multidisciplinary Orthopaedic Oncology Conference?

First trimester anomaly scan using virtual reality (VR FETUS study): study protocol for a randomized clinical trial

Cost-effectiveness Analysis in Diagnostic Musculoskeletal Radiology: A Systematic Review

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