Alexander Peter Lin, Presenter: Nothing to Disclose

Brian D. Ross MD, Abstract Co-Author: Nothing to Disclose

The utility and accuracy of MRS has been well established in 1000+ studies. Cost-benefit analysis of MRS has never been published and may demonstrate that MRS is not only a safe and accurate diagnostic tool but a cost-effective one as well.

15 consecutive patients were examined by a neurosurgeon who mapped a management plan. Single voxel short-echo proton MRS was then conducted in all 15 patients. The MRS results were then reported to the clinician, factored into the clinical decision-making and a final diagnostic and treatment plan was formulated. The diagnostic costs of the initial treatment plan were determined using CPT codes of the recommended procedures. Hospital costs were determined by using average medical fees in the 50th percentile for those codes. Cost savings due to MRS were determined by changes in the treatment plan which led to more cost-effective means of treatment minus the cost of a single MRS exam per patient.

In the initial treatment plan, stereotactic biopsy was recommended in eight cases, repeat MRI every 6 weeks in three cases, resection in the another three cases, and proceed to chemotherapy in the final case. This would have come to a total cost of $90,026. In the final treatment plan, stereotactic biopsy was avoided in seven of eight cases. This alone was a cost savings of $40,768. In addition, the morbidity rate of biopsy is approximately 3-4% compared to 0% in a non-invasive test such as MRS. Instead of repeat MRI, the MRS results intiated prompt treatment in two cases. MRS not only resulted in savings of $5,094 but initiated faster decision making thereby increasing treatment success. In one resection case, MRS showed radiation necrosis and resection was decided against. This resulted in a cost-savings of $3,590 for unnecessary surgery. In remaining cases, MRS confirmed recurrent tumor and the original treatment plan was executed.

The total cost savings of MRS in the clinical management of just these 15 patients was $49,452, an average of $3,296.80 per patient. Considering that there are over 17,000 new cases of brain tumor diagnosed each year, the cost savings of spectroscopy could be at least $56.1 million a year.

Lin, A, Ross, B, Cost-Effectiveness and Efficacy of Proton Magnetic Resonance Spectroscopy (MRS) in the Management of Recurrent and High Risk Brain Tumors.  Radiological Society of North America 2004 Scientific Assembly and Annual Meeting, November 28 - December 3, 2004 ,Chicago IL. http://archive.rsna.org/2004/4412498.html