Cost-effective diagnosis of acoustic neuromas: a philosophical, macroeconomic, and technological decision.
OBJECTIVE
Our goals were to define the most sensitive techniques of acoustic neuroma diagnosis, to examine their relative costs, and to propose diagnostic modality selection given the rarity of acoustic neuroma incidence and given the other costs that society faces in more commonly encountered diseases.


METHODS
We conducted a MEDLINE search of the English language from 1966 to 2001 using the following keywords: acoustic neuroma, acoustic tumor, vestibular schwannoma, diagnosis, cost effectiveness, MRI, auditory brainstem response, brainstem audiometric evoked response, incidence, and prevalence.


RESULTS
Although magnetic resonance imaging with gadolinium remains the most sensitive diagnostic modality in the discovery of acoustic neuromas, its cost may be prohibitive for some societies.


CONCLUSIONS
Which modality to use in acoustic neuroma diagnosis is just as much a philosophical and macroeconomic question as a technological one.


CONCLUSIONS
The cost of a timely diagnosis of acoustic neuromas must be weighed against using resources for other, more pressing, health concerns.
Murphy
Mark R
MR
Department of Otorhinolaryngology, Weill College of Medicine of Cornell University, New York, New York 10021, USA.
Selesnick
Samuel H
SH
D001300:Audiometry, Evoked Response / Q000191:economics* / Q000379:methods; D003362:Cost-Benefit Analysis; D016057:Evoked Potentials, Auditory, Brain Stem; D005260:Female; D019786:Gadolinium DTPA / Q000191:economics; D005102:Health Expenditures; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000191:economics* / Q000379:methods; D008297:Male; D009464:Neuroma, Acoustic / Q000175:diagnosis* / Q000191:economics*; D014481:United States
D019786:Gadolinium DTPA