MP16-07 IMPLICATIONS OF REGIONALIZING FUSION MRI TECHNOLOGY

Abstract

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness I1 Apr 2015MP16-07 IMPLICATIONS OF REGIONALIZING FUSION MRI TECHNOLOGY Karen Wheeler, Jennifer Lobo, Drew Jensen, Jules Manger, Shawnna Blanchard, Afshan Ornan, Sebastian Feuerlain, and Tracey Krupski Karen WheelerKaren Wheeler More articles by this author , Jennifer LoboJennifer Lobo More articles by this author , Drew JensenDrew Jensen More articles by this author , Jules MangerJules Manger More articles by this author , Shawnna BlanchardShawnna Blanchard More articles by this author , Afshan OrnanAfshan Ornan More articles by this author , Sebastian FeuerlainSebastian Feuerlain More articles by this author , and Tracey KrupskiTracey Krupski More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.814AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Magnetic resonance imaging fusion technology (fusion MRI) is increasingly used to target clinically significant prostate cancer (PCa) over conventional cognitive fusion MRI. There are many ways to disseminate such new technology such as wide dispersion as with CT scanners or regionalization as with lithotripsy. Given the high cost of fusion MRI, we sought to determine the cost and diagnostic implications of using regionalization versus dispersion. METHODS We identified the distribution of prostatectomies at the county level in Virginia using state data from the Department of Health Patient Level Database System via the Thomson Reuters Polaris Suite for the time period 2012–13. Using Mid-Atlantic AUA rosters, we identified Virginia urology practices comprised of more than 2 persons (N = 25). The p-median problem was employed to identify optimal placement of 4 fusion centers to minimize the average patient travel distance from a patient's home county to a fusion center. We compared cancer detection rates (CDRs) in the literature for cognitive fusion and fusion MRI. Cost per additional patient diagnosis was calculated using the number of practices, estimated diagnoses of clinically significant cancer, and published MRI fusion cost of $250,000. Three dissemination models that take into account patient access to technology and the number of centers. RESULTS In 2012–13, 2049 men in Virginia were diagnosed with clinically significant PCa. Based on cognitive fusion CDRs, we estimated that 4360 patients were screened. Published CDRs show 6% higher detection with fusion MRI over cognitive fusion. Table 1 displays diagnosis and cost outcomes for each scenario: every practice having fusion MRI (One for All), and fusion MRI for each of the 4 optimally placed centers using screening for surrounding counties (Proximity Screening) or the entire state (Screening for All). While regional proximity screening reduced costs, the number of additional diagnoses was lower than when every patient was screened with fusion MRI. CONCLUSIONS While it is important to detect clinically relevant PCa, our data highlights that how the technology is disseminated has cost implications. The tradeoffs between cancer detection and cost of technology emphasize the need for thoughtful dissemination of fusion MRI. Dissemination Model One for All Regionalization type: Regionalization type: Proximity Screening Screening for All Fusion Centers 25 4 4 Total cost of technology $6.25 million $1 million $1 million MRI fusion Screened patients 4360 1874 4360 Additional patients diagnosed 262 112 262 Cost per additional diagnosis $23,894 $8,891 $3,823 © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e170 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Karen Wheeler More articles by this author Jennifer Lobo More articles by this author Drew Jensen More articles by this author Jules Manger More articles by this author Shawnna Blanchard More articles by this author Afshan Ornan More articles by this author Sebastian Feuerlain More articles by this author Tracey Krupski More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...