Cost-effectiveness of Diagnostic Ultrasound in Focal Neuropathies
Arvin Raj Wali, BA1; Charlie Park, BS1; Dina Hingorani, PhD1; Milli Desai, BS1; Justin M. Brown, MD1; Michael Cartwright, MD2; Ross Mandeville, MD1
1University of California, San Diego, San Diego, CA, 2Wakeforest, Salem, NJ
Recently, a prospective trial (Cartwright et al., 2015) evaluating the use of ultrasound in addition to electrophysiology for the assessment of focal neuropathy detected improvement in the SF-36 when ultrasound was used. The original study randomized 120 patients with focal neuropathies to either have their ultrasound reports sent or not sent to their management teams. Previously, we extracted SF-6D scores, a preference-based health related quality of life (HR-QOL) index, from the original SF-36 scores and found a significant (p<0.012) and clinically meaningful improvement in SF-6D score between baseline and 6-month follow-up when ultrasound was used but not when only electrophysiology was relied upon (p<0.689). Using this information, this study goes further and evaluates the cost-effectiveness of diagnostic ultrasound in focal neuropathy.
Using TreeAge Pro, a Markov model was constructed to assess the cost-effectiveness of ultrasound for a 54 year old patient seeking treatment for focal neuropathy. Cost of ultrasound was derived from Medicare CPT codes and quality adjusted life years (QALYs) were derived from the SF-6D scores reported by Cartwright et al. All dollars were reported in $2016 values. A willingness to pay threshold of $50,000/QALY gained was used to assess cost-efficacy.
Ultrasound was highly inexpensive associated with a one-time cost of $36. However, across a lifetime, patients that underwent ultrasound had a 0.5 lifetime gain in QALY compared to patients that did not have ultrasound performed. Our model demonstrated an incremental cost-effectiveness ratio of $72/QALY gained indicating that ultrasound used in the diagnosis and treatment of focal neuropathy is an extremely cost-effective modality.
In addition to prior evidence that diagnostic ultrasound is valid, reliable, and accurate in the diagnosis of focal neuropathy, this study goes further and finds that the use of diagnostic ultrasound is highly cost-effective and should be considered in the evaluation and management of focal neuropathies.
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