The Economic Value of MR-Imaging for Uveal Melanoma

Lorna Grech Fonk,1,2 Teresa A Ferreira,2 Andrew G Webb,2,3 Gregorius PM Luyten,1 Jan-Willem M Beenakker1,2 1Department of Ophthalmology, Leiden University Medical Centre, Leiden, the Netherlands; 2Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands; 3C.J. Gorter Centre...

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Autores principales:	Grech Fonk L, Ferreira TA, Webb AG, Luyten GPM, Beenakker JWM
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2020
Materias:	uveal melanoma ocular tumour mri radiotherapy oncological imaging ultrasound Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/94a18544315d44d0be52b5627c3b4a4f
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spelling	oai:doaj.org-article:94a18544315d44d0be52b5627c3b4a4f2021-12-02T13:22:27ZThe Economic Value of MR-Imaging for Uveal Melanoma1177-5483https://doaj.org/article/94a18544315d44d0be52b5627c3b4a4f2020-04-01T00:00:00Zhttps://www.dovepress.com/the-economic-value-of-mr-imaging-for-uveal-melanoma-peer-reviewed-article-OPTHhttps://doaj.org/toc/1177-5483Lorna Grech Fonk,1,2 Teresa A Ferreira,2 Andrew G Webb,2,3 Gregorius PM Luyten,1 Jan-Willem M Beenakker1,2 1Department of Ophthalmology, Leiden University Medical Centre, Leiden, the Netherlands; 2Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands; 3C.J. Gorter Centre for High Field Magnetic Resonance Imaging, Department of Radiology, Leiden University Medical Centre, Leiden, the NetherlandsCorrespondence: Lorna Grech FonkDepartment of Ophthalmology, Leiden University Medical Centre, Leiden, the NetherlandsEmail l.grech_fonk@lumc.nlObjective: Uveal melanoma (UM) is the most common primary intra-ocular tumour. Treatment is determined by tumour size and location. Generally, smaller tumours are eligible for brachytherapy unless they are located close to posterior pole. Larger tumours are enucleated or undergo proton beam therapy (PBT), which is more expensive than brachytherapy and less available. Accuracy of tumour size determination is critical for accurate planning and delivery of treatment, particularly to ensure tumour coverage, critical structure sparing, and for the choice of treatment modality. This is particularly the case for tumour dimensions that are close to the cut-off point for a specific type of treatment: in the case of the brachytherapy protocol at our institution, 6– 8 mm. Ultrasound is conventionally used, but magnetic resonance imaging (MRI) has recently become an additional available tool. Although more expensive, it enables more accurate measurements and is particularly useful in combination with clinical fundus examination, fundus photography and ultrasound. Our aim in this paper was to determine the economic value of MRI for UM treatment.Methods: We retrospectively analysed 60 patients’ MRI scans acquired as part of a study or for clinical care. For each patient, we assessed whether the extra cost of an MRI generated economic benefit or change in optimal treatment.Results: MRI indicated a smaller tumour prominence than US in 10% of patients with intermediate tumour size, resulting in a change from PBT to brachytherapy. The costs of MRI, € 200–€ 1000, are significantly lower than the higher costs of PBT compared to brachytherapy, € 24,000 difference. In addition, the annual total economic burden of severe vision impairment associated with eye removal is € 10,000. Furthermore, for patients where ultrasound was impossible due to previous surgery, MRI enabled eye-preserving treatment.Conclusion: An additional MRI for specific patients with UM improves economic value as it enables less expensive treatment in a sufficient percentage of patients to compensate for the MRI costs. Value is increased in terms of quality of care as it enables for some a treatment option which spares more vision.Keywords: uveal melanoma, ocular tumour, MRI, radiotherapy, oncological imaging, ultrasound, eye diseasesGrech Fonk LFerreira TAWebb AGLuyten GPMBeenakker JWMDove Medical Pressarticleuveal melanoma ocular tumour mri radiotherapy oncological imaging ultrasoundOphthalmologyRE1-994ENClinical Ophthalmology, Vol Volume 14, Pp 1135-1143 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	uveal melanoma ocular tumour mri radiotherapy oncological imaging ultrasound Ophthalmology RE1-994
spellingShingle	uveal melanoma ocular tumour mri radiotherapy oncological imaging ultrasound Ophthalmology RE1-994 Grech Fonk L Ferreira TA Webb AG Luyten GPM Beenakker JWM The Economic Value of MR-Imaging for Uveal Melanoma
description	Lorna Grech Fonk,1,2 Teresa A Ferreira,2 Andrew G Webb,2,3 Gregorius PM Luyten,1 Jan-Willem M Beenakker1,2 1Department of Ophthalmology, Leiden University Medical Centre, Leiden, the Netherlands; 2Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands; 3C.J. Gorter Centre for High Field Magnetic Resonance Imaging, Department of Radiology, Leiden University Medical Centre, Leiden, the NetherlandsCorrespondence: Lorna Grech FonkDepartment of Ophthalmology, Leiden University Medical Centre, Leiden, the NetherlandsEmail l.grech_fonk@lumc.nlObjective: Uveal melanoma (UM) is the most common primary intra-ocular tumour. Treatment is determined by tumour size and location. Generally, smaller tumours are eligible for brachytherapy unless they are located close to posterior pole. Larger tumours are enucleated or undergo proton beam therapy (PBT), which is more expensive than brachytherapy and less available. Accuracy of tumour size determination is critical for accurate planning and delivery of treatment, particularly to ensure tumour coverage, critical structure sparing, and for the choice of treatment modality. This is particularly the case for tumour dimensions that are close to the cut-off point for a specific type of treatment: in the case of the brachytherapy protocol at our institution, 6– 8 mm. Ultrasound is conventionally used, but magnetic resonance imaging (MRI) has recently become an additional available tool. Although more expensive, it enables more accurate measurements and is particularly useful in combination with clinical fundus examination, fundus photography and ultrasound. Our aim in this paper was to determine the economic value of MRI for UM treatment.Methods: We retrospectively analysed 60 patients’ MRI scans acquired as part of a study or for clinical care. For each patient, we assessed whether the extra cost of an MRI generated economic benefit or change in optimal treatment.Results: MRI indicated a smaller tumour prominence than US in 10% of patients with intermediate tumour size, resulting in a change from PBT to brachytherapy. The costs of MRI, € 200–€ 1000, are significantly lower than the higher costs of PBT compared to brachytherapy, € 24,000 difference. In addition, the annual total economic burden of severe vision impairment associated with eye removal is € 10,000. Furthermore, for patients where ultrasound was impossible due to previous surgery, MRI enabled eye-preserving treatment.Conclusion: An additional MRI for specific patients with UM improves economic value as it enables less expensive treatment in a sufficient percentage of patients to compensate for the MRI costs. Value is increased in terms of quality of care as it enables for some a treatment option which spares more vision.Keywords: uveal melanoma, ocular tumour, MRI, radiotherapy, oncological imaging, ultrasound, eye diseases
format	article
author	Grech Fonk L Ferreira TA Webb AG Luyten GPM Beenakker JWM
author_facet	Grech Fonk L Ferreira TA Webb AG Luyten GPM Beenakker JWM
author_sort	Grech Fonk L
title	The Economic Value of MR-Imaging for Uveal Melanoma
title_short	The Economic Value of MR-Imaging for Uveal Melanoma
title_full	The Economic Value of MR-Imaging for Uveal Melanoma
title_fullStr	The Economic Value of MR-Imaging for Uveal Melanoma
title_full_unstemmed	The Economic Value of MR-Imaging for Uveal Melanoma
title_sort	economic value of mr-imaging for uveal melanoma
publisher	Dove Medical Press
publishDate	2020
url	https://doaj.org/article/94a18544315d44d0be52b5627c3b4a4f
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The Economic Value of MR-Imaging for Uveal Melanoma

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