MRI-Guided and CT-Guided Cervical Nerve Root Infiltration Therapy: A Cost Comparison

Abstract

Purpose: To evaluate and compare the costs of MRI-guided and CT-guided cervical nerve root infiltration for the minimally invasive treatment of radicular neck pain.

Materials and Methods: Between September 2009 and April 2012, 22 patients (9 men, 13 women; mean age: 48.2 years) underwent MRI-guided (1.0 Tesla, Panorama HFO, Philips) single-site periradicular cervical nerve root infiltration with 40 mg triamcinolone acetonide. A further 64 patients (34 men, 30 women; mean age: 50.3 years) were treated under CT fluoroscopic guidance (Somatom Definition 64, Siemens). The mean overall costs were calculated as the sum of the prorated costs of equipment use (purchase, depreciation, maintenance, and energy costs), personnel costs and expenditure for disposables that were identified for MRI- and CT-guided procedures. Additionally, the cost of ultrasound guidance was calculated.

Results: The mean intervention time was 24.9 min. (range: 12 – 36 min.) for MRI-guided infiltration and 19.7 min. (range: 5 – 54 min.) for CT-guided infiltration. The average total costs per patient were EUR 240 for MRI-guided interventions and EUR 124 for CT-guided interventions. These were (MRI/CT guidance) EUR 150/60 for equipment use, EUR 46/40 for personnel, and EUR 44/25 for disposables. The mean overall cost of ultrasound guidance was EUR 76.

Conclusion: Cervical nerve root infiltration using MRI guidance is still about twice as expensive as infiltration using CT guidance. However, since it does not involve radiation exposure for patients and personnel, MRI-guided nerve root infiltration may become a promising alternative to the CT-guided procedure, especially since a further price decrease is expected for MRI devices and MR-compatible disposables. In contrast, ultrasound remains the less expensive method for nerve root infiltration guidance.

Citation Format:

• Maurer MH, Froeling V, Röttgen R et al. MRI-Guided and CT-Guided Cervical Nerve Root Infiltration Therapy: A Cost Comparison. Fortschr Röntgenstr 2014; 186: 559 – 566

Zusammenfassung

Ziel: Ein Vergleich der Kosten periradikulärer Nervenwurzelinfiltrationen an der Halswirbelsäule unter Computertomografie (CT)- und alternativ Magnetresonanztomografie (MRT)- Therapiesteuerung.

Material und Methoden: In einem Zeitraum von September 2009 bis April 2012 erhielten 22 Patienten (9 Männer, 13 Frauen; Durchschnittsalter 48,2 Jahre) eine MRT-gesteuerte (1,0 Tesla, Panorama HFO, Philips) monosegmental-unilaterale periradikuläre Nervenwurzelinfiltration an der Halswirbelsäule mit 40 mg Triamcinolonacetonid. Im gleichen Zeitraum wurden weitere 64 Patienten (34 Männer, 30 Frauen; Durchschnittsalter 50,3 Jahre) unter CT-fluoroskopischer Steuerung (Somatom Definition 64, Siemens) in gleicher Weise behandelt. Die Gesamtkosten für die CT- und MRT-gesteuerten Interventionen wurden als Summe aus den Gerätenutzungskosten (Anschaffungs- und Abschreibungskosten sowie Wartungskosten und Energiekosten), den Personalkosten basierend auf der Personalbindungszeit und den Kosten für das verwendete Verbrauchsmaterial ermittelt. Zusätzlich wurden die Kosten einer sonografischen Therapiesteuerung evaluiert.

Ergebnisse: Die durchschnittliche Interventionszeit betrug 24,9 Minuten (Min. 17, Max. 36 Minuten) für eine MRT-gesteuerte und 19,7 Minuten (Min 5, Max 54 Minuten) für eine CT-gesteuerte Infiltration. Die durchschnittlichen Gesamtkosten je Patient beliefen sich auf EUR 240 für eine MRT-gesteuerte und EUR 124 für eine CT-gesteuerte Therapie. Dies waren (MRT-/CT-gesteuert) EUR 150/60 je Intervention für die Gerätenutzung, EUR 46/40 für Personalkosten und EUR 44/25 für Verbrauchsmaterialien. Die Ultraschallsteuerung wies Gesamtkosten in Höhe von EUR 76 auf.

Schlussfolgerung: Zervikale Nervenwurzelinfiltrationen unter MRT-Steuerung sind aktuell noch etwa doppelt so teuer wie Interventionen unter CT-Steuerung. Eine fehlende Strahlenexposition der Patienten und zukünftig zu erwartende Preissenkungen für MRT-Systeme und MRT-taugliche Verbrauchsmaterialien machen MRT-gesteuerte periradikuläre Injektionstherapien jedoch zu einer vielversprechenden Alternative zur bisher üblichen CT-fluoroskopischen Steuerung. Das kostengünstige Verfahren bleibt jedoch eine Therapiesteuerung mittels Ultraschall.

Key words

nerve root infiltration - MRI fluoroscopy - CT fluoroscopy - cost analysis - health economics

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