title: A two-tiered approach to MRI for hearing loss: incremental cost of a comprehensive MRI over high-resolution T2-weighted imaging.
abstract: OBJECTIVE
  The objective of our study was to compare the cost-effectiveness of two approaches to using MRI for the evaluation of patients with hearing loss.
  
  
  METHODS
  We developed a decision tree to compare the cost-effectiveness of conventional MRI with that of a proposed two-tiered model in which an initial 3D T2-weighted imaging examination was used to determine the need for comprehensive MR scanning. Three radiologists independently and blindly reviewed the 3D T2-weighted images acquired as part of the comprehensive MR examinations of 256 patients with hearing loss to assess the diagnostic efficacy of the two-tiered approach. Costs were defined in terms of both the scanner utilization time for the imaging facility and the dollar amount for payers. Effectiveness was defined in terms of the ability to correctly detect the presence or absence of disease.
  
  
  RESULTS
  The conventional approach was less cost-effective, with a baseline incremental cost-effectiveness ratio (ICER) of 27,299 minutes of scanner utilization per unit increase in effectiveness. Assuming a 50% reduction in the reimbursement of the technical component from the current level by the Centers for Medicare & Medicaid Services, this result reflected an ICER of $258,664 per unit increase in effectiveness. The results of a sensitivity analysis showed the robustness of the cost-effectiveness of the two-tiered imaging approach in a variety of scenarios that reflect differences in scanning practices and possible differences in recall rates. The conventional imaging approach was absolutely dominated by the two-tiered approach in the scenarios created to reflect the expected range of prevalence of disease.
  
  
  CONCLUSIONS
  A two-tiered approach to MRI provides a more cost-effective alternative to the current approach of using a comprehensive MRI examination without and with contrast material to evaluate patients with hearing loss.
authors.affiliation: 1 Mallinckrodt Institute of Radiology, Washington University School of Medicine, Campus Box 8131, 510 S Kingshighway Blvd, St. Louis, MO 63110.
authors.forename: Aseem
authors.initials: A
authors.lastname: Sharma
authors.forename: Ryan
authors.initials: R
authors.lastname: Viets
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Parsons
authors.forename: Martin
authors.initials: M
authors.lastname: Reis
authors.forename: John
authors.initials: J
authors.lastname: Chrisinger
authors.forename: Franz J
authors.initials: FJ
authors.lastname: Wippold
mesh_terms: D003287:Contrast Media; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D005260:Female; D006319:Hearing Loss, Sensorineural / Q000175:diagnosis*; D006801:Humans; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging / Q000191:economics* / Q000379:methods*; D008297:Male; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies
chemical_list: D003287:Contrast Media