title: Auditory brainstem response - a valid and cost-effective screening tool for vestibular schwannoma?
abstract: CONCLUSIONS
  Contemporary auditory brainstem response (ABR) is not valid as a screening tool for VS, when considering the sensitivity of 80%, the specificity of 77%, and the positive predictive value of 3.4%, MRI screening is superior to ABR in Denmark when considering cost-effectiveness.
  
  
  OBJECTIVE
  The aim of this study is to assess the sensitivity, specificity, and cost-effectiveness of ABR vs MRI, when screening for VS in a clinical setting.
  
  
  METHODS
  Data was collected on all patients subjected to an ABR during a 3-year period (2005-2008) at a tertiary referral center. The data were compared to results of MRI and with data from The Danish National VS Database. In total, 1447 adults underwent ABR, of whom 349 were referred for a subsequent MRI. Sensitivity and specificity were calculated. To assess the cost-effectiveness of ABR vs MRI, procedure costs for ABR and MRI were retrieved from the National Board of Health.
  
  
  RESULTS
  Twelve (3.4%) of 349 patients were diagnosed with a VS. Of the 1098 patients not referred for MRI, three (0.3%) were later diagnosed with a VS. The sensitivity and specificity of ABR in diagnosing a VS were 80% and 77%, respectively. Procedure costs were 326 EURO for the ABR and 319 EURO for the MRI.
authors.affiliation: a Department of Oto-Rhino-Laryngology, Head and Neck Surgery, and Audiology F2074 , Copenhagen University Hospital Rigshospitalet , Copenhagen , Denmark ;
authors.forename: Irfan
authors.initials: I
authors.lastname: Rafique
authors.affiliation: a Department of Oto-Rhino-Laryngology, Head and Neck Surgery, and Audiology F2074 , Copenhagen University Hospital Rigshospitalet , Copenhagen , Denmark ;
authors.forename: Kasper
authors.initials: K
authors.lastname: Wennervaldt
authors.affiliation: a Department of Oto-Rhino-Laryngology, Head and Neck Surgery, and Audiology F2074 , Copenhagen University Hospital Rigshospitalet , Copenhagen , Denmark ;|b The Faculty of Health and Medical Sciences , University of Copenhagen , Denmark.
authors.forename: Jacob
authors.initials: J
authors.lastname: Melchiors
authors.affiliation: a Department of Oto-Rhino-Laryngology, Head and Neck Surgery, and Audiology F2074 , Copenhagen University Hospital Rigshospitalet , Copenhagen , Denmark ;|b The Faculty of Health and Medical Sciences , University of Copenhagen , Denmark.
authors.forename: Per
authors.initials: P
authors.lastname: Caye-Thomasen
mesh_terms: D003362:Cost-Benefit Analysis; D016057:Evoked Potentials, Auditory, Brain Stem; D006801:Humans; D009464:Neuroma, Acoustic / Q000175:diagnosis*; D012189:Retrospective Studies
keywords: Auditory brainstem response; magnetic resonance scanning; sensitivity; vestibular schwannoma