Is intraoperative MRI cost-effective for treating gliomas?

Intraoperative MRI can be a cost-effective method for treating patients with high-grade gliomas, according to results of a microsimulation model study published in Radiology.

A five-state microsimulation model compared 100,000 patients who underwent intraoperative MRI for high-grade glioma to 100,000 with the same high-grade tumors who were treated with neuronavigation systems. MRI offers surgeons the benefit of real-time intraoperative imaging, while neuronavigation does not.

Following a multivariable calculation, the model found intraoperative MRI maximizes results from glioma resection while providing patients with an average of 1.5 additional months of progression-free survival. And when adjusted for a patient’s postsurgery quality of life years (QALYs), intraoperative MRI, though more expensive, was more cost-effective than the more commonly used neuronavigation technology.

“Despite wide variation in published values, microsimulation modeling demonstrated that intraoperative MRI was a cost-effective adjunct for high-grade glioma resection in patients of all ages undergoing up to three resections, regardless of prognosis,” wrote first author, Peter Abraham of the University of California, San Diego (UCSD), and colleagues.

Additionally, Abraham and colleagues noted, surgeons should feel comfortable using the MRI technique in older patients or those nearing the end of life, finding the modality was cost-effective in participants with a probability of a one-month survival near to zero.

Intraoperative MRI has been shown to improve gross-total resection and progression-free survival rates, but its cost-effectiveness has remained a concern. To address this, the researchers created their computer model to simulate the time period from initial tumor resection until death. The model accounted for age, clinical status, treatment regimen, adverse effects of therapy, expense of intraoperative MRI, costs incurred by the patient, postprocedure longevity and quality of life. To determine cost-effectiveness, Abraham et al. selected a willingness-to-pay threshold of $100,000 per quality-adjusted life year.

They found intraoperative MRI produced a benefit of 0.18 QALYs per patient on top of the 1.5 additional months of progression-free survival. MRI was found to be $13,477 more expensive than neuronavigation. MRI demonstrated a 99.5% chance of cost-effectiveness at the established willingness-to-pay threshold.

“Our study adds to the growing body of evidence that demonstrates the cost effectiveness of intraoperative MRI,” the authors wrote. “Further study of health-related quality of life may improve the ability to predict which interventions improve quality of life in patients with high-grade gliomas.”