title: Cost-effectiveness of high-dose MR contrast studies in the evaluation of brain metastases.
abstract: OBJECTIVE
  To investigate the cost-effectiveness of high-dose MR contrast studies in the management of brain metastases.
  
  
  METHODS
  During the phase III clinical trial of high-dose contrast studies (0.3 mmol/kg), 11 of 27 patients were judged by the reviewers to have potential treatment changes based on the additional information provided by the high-dose studies. We retrospectively evaluated how many of these 27 patients had actual treatment changes because of the results of the high-dose study. Using the fee schedule at our institution, the cost-effectiveness was analyzed based on the cost savings from treatment changes and the additional expense of implementing the high-dose studies.
  
  
  RESULTS
  A total of 3 craniotomies ($22,800 each) and 2 aggressive courses of radiation therapy ($1122 each) were avoided in 4 patients because of the additional lesions detected by the high-dose studies. This resulted in a treatment cost savings of $70,644. The extra expense for implementing the high-dose study is $9126 for a single injection in all 27 patients, $9295 for 2 separate injections completed in 1 visit in the 11 patients, and $11,154 for 2 separate injections completed in 2 separate visits. The cost savings in management (diagnosis and treatment) therefore ranged from $59,490 to $61,518 for all patients and from $2203 to $2278 per patient.
  
  
  CONCLUSIONS
  Based on our limited data, the high-dose study seems to impact positively on the cost-effectiveness in the management of brain metastases. However, because our study had limitations, our results need to be confirmed with a larger patient population and a more standardized treatment approach and fee schedule.
authors.affiliation: Department of Radiology, University of Iowa College of Medicine, Iowa City.
authors.forename: N A
authors.initials: NA
authors.lastname: Mayr
authors.forename: W T
authors.initials: WT
authors.lastname: Yuh
authors.forename: M G
authors.initials: MG
authors.lastname: Muhonen
authors.forename: D J
authors.initials: DJ
authors.lastname: Fisher
authors.forename: H D
authors.initials: HD
authors.lastname: Nguyen
authors.forename: J C
authors.initials: JC
authors.lastname: Ehrhardt
authors.forename: B C
authors.initials: BC
authors.lastname: Wen
authors.forename: J F
authors.initials: JF
authors.lastname: Doornbos
authors.forename: D H
authors.initials: DH
authors.lastname: Hussey
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000191:economics / Q000556:secondary* / Q000628:therapy; D003287:Contrast Media / Q000008:administration & dosage; D003362:Cost-Benefit Analysis; D005682:Gadolinium / Q000008:administration & dosage; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000191:economics*; D008875:Middle Aged; D010347:Patient Care Planning; D012189:Retrospective Studies; D013675:Technology, High-Cost
chemical_list: D003287:Contrast Media; D005682:Gadolinium