J Neurol Surg B Skull Base 2016; 77 - FP-13-03
DOI: 10.1055/s-0036-1592502

Room for Improvement in the Diagnostic Pathway of Patients Suspected of Vestibular Schwannoma

Mayke Hentschel 1, *, Mirre Scholte 2, *, Stefan Steens 3, Dirk Kunst 1, Maroeska Rovers 2, Janneke Grutters 2
  • 1Department of Otolaryngology, Radboud University Medical Center, Nijmegen, The Netherlands
  • 2Department of Operating Rooms, Radboud University Medical Center, Nijmegen, The Netherlands
  • 3Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
  • *Both the authors contributed equally to this article.

Objective: Diagnostic MRI investigations for vestibular schwannoma (VS) are costly, and have an extremely low yield of only 3%. This implies that there is much room for improvement. We have quantified this room for improvement in the diagnostic pathway (DP) to facilitate the development of innovative strategies and informed decision making.

Methods: To simulate the costs of the current DP, we built a decision analytical model with probabilities derived from literature and expert opinion. The current DP was plotted against two perfect DPs, assigning MRI to: (1) patients with VS and (2) patients with VS or other important pathology. Costs of the perfect DPs were calculated. Extra costs made due to the introduction of new DPs were not included in the analysis.

Results: Using a perfect DP, savings would amount to €293 per patient if only patients with VS would receive a diagnostic MRI, and to €283 per patient if patients with VS and those with other important pathology would receive a diagnostic MRI. Future DPs can cost up to these amounts per patient and still be cost saving.

Conclusion: There is substantial room for improvement in the DP for VS from an economic point of view. This information can be used in evaluation of cost-effectiveness and informed decision making.