Comparative effectiveness of CT and MR imaging for surveillance of pediatric thoracoabdominal neoplasms
Computed tomography (CT) and magnetic resonance (MR) imaging are the most commonly used imaging modalities for the initial staging and surveillance of pediatric thoracoabdominal neoplasms. Because these modalities are diagnostically equivalent for most thoracoabdominal tumors, costs and safety concerns largely dictate the choice of modality for imaging infants and young children. The primary long-term risk of CT is radiation-induced malignancy and the primary long-term risk of MR with anesthesia is anesthesia-induced neurocognitive deficits. A decision-analytic model was constructed to compare the cost-utility of CT with iodinated intravenous contrast to MR with sedation and gadolinium-based intravenous contrast. Event probabilities, costs, and utility estimates were generated from the literature. Monte Carlo simulation and one-way sensitivity analysis of critical model parameters were performed using the base-case of a four year-old boy. Based on base-case parameter estimates, CT is both less costly and more effective that MR with sedation for surveillance imaging. One-way sensitivity analysis showed that the parameters with greatest impact on model outcome were the probability of radiation-induced malignancy following low dose radiation exposure, the probability of anesthesia-induced neurocognitive deficits, and the impairment in quality of life associated with anesthesia-induced neurocognitive deficits. Future work with this model will focus on probabilistic sensitivity analysis to further define the most critical model parameters and input of refined estimates of the effects of anesthesia on neurocognitive development as such evidence becomes available.
Orth, Robert Chappell, "Comparative effectiveness of CT and MR imaging for surveillance of pediatric thoracoabdominal neoplasms" (2015). Texas Medical Center Dissertations (via ProQuest). AAI10036302.