COST-EFFECTIVENESS OF HIGH-DOSE MR CONTRAST STUDIES IN THE EVALUATIONOF BRAIN METASTASES

PURPOSE: To investigate the cost-effectiveness of high-dose MR contras t studies in the management of brain metastases. METHODS: During the p hase III clinical trial of high-dose contrast studies (0.3 mmol/kg), 1 1 of 27 patients were judged by the reviewers to have potential treatm ent changes based on the additional information provided by the high-d ose studies. We retrospectively evaluated how many of these 27 patient s had actual treatment changes because of the results of the high-dose study. Using the fee schedule at our institution, the cost-effectiven ess was analyzed based on the cost savings from treatment changes and the additional expense of implementing the high-dose studies. RESULTS: A total of 3 craniotomies ($22 800 each) and 2 aggressive courses of radiation therapy ($1122 each) were avoided in 4 patients because of t he additional lesions detected by the high-dose studies. This resulted in a treatment cost savings of $70 644. The extra expense for impleme nting the high-dose study is $9126 for a single injection in all 27 pa tients, $9295 for 2 separate injections completed in 1 visit in the 11 patients, and $11 154 for 2 separate injections completed in 2 separa te visits. The cost savings in management (diagnosis and treatment) th erefore ranged from $59 490 to $61 518 for all patients and from $2203 to $2278 per patient. CONCLUSION: Based on our limited data, the high -dose study seems to impact positively on the cost-effectiveness in th e management of brain metastases. However, because our study had limit ations, our results need to be confirmed with a larger patient populat ion and a more standardized treatment approach and fee schedule.