{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T07:34:43Z","timestamp":1789112083476,"version":"build-2803163510"},"reference-count":24,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2017,9,7]],"date-time":"2017-09-07T00:00:00Z","timestamp":1504742400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"name":"Health Care Efficiency Research"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinical Otolaryngology"],"published-print":{"date-parts":[[2018,2]]},"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Magnetic resonance imaging (<jats:styled-content style=\"fixed-case\">MRI<\/jats:styled-content>) is used to screen patients at risk for vestibular schwannoma (<jats:styled-content style=\"fixed-case\">VS<\/jats:styled-content>). These <jats:styled-content style=\"fixed-case\">MRI<\/jats:styled-content>s are costly and have an extremely low yield; only 3% of patients in the screening population has an actual <jats:styled-content style=\"fixed-case\">VS<\/jats:styled-content>. It might be worthwhile to develop a test to predict <jats:styled-content style=\"fixed-case\">VS<\/jats:styled-content> and refer only a subset of all patients for <jats:styled-content style=\"fixed-case\">MRI<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To examine the potential savings of such a hypothetical diagnostic test before <jats:styled-content style=\"fixed-case\">MRI<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>We built a decision analytical model of the diagnostic strategy of <jats:styled-content style=\"fixed-case\">VS<\/jats:styled-content>. Input was derived from literature and key opinion leaders. The current strategy was compared to hypothetical new strategies, assigning <jats:styled-content style=\"fixed-case\">MRI<\/jats:styled-content> to the following: (i) all patients with pathology, (ii) all patients with important pathology and (iii) only patients with <jats:styled-content style=\"fixed-case\">VS<\/jats:styled-content>. This resulted in potential cost savings for each strategy. We conducted a budget impact analysis to predict nationwide savings for the Netherlands and the United Kingdom (<jats:styled-content style=\"fixed-case\">UK<\/jats:styled-content>), and a probabilistic sensitivity analysis to address uncertainty.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Mean savings ranged from \u20ac256 (95%<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> \u20ac250 \u2010 \u20ac262) or approximately <jats:styled-content style=\"fixed-case\">US<\/jats:styled-content>$284 (95%<jats:styled-content style=\"fixed-case\">CI US<\/jats:styled-content>$277 \u2010 <jats:styled-content style=\"fixed-case\">US<\/jats:styled-content>$291) per patient for strategy 1 to \u20ac293 (95%<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> \u20ac290 \u2010 \u20ac296) or approximately <jats:styled-content style=\"fixed-case\">US<\/jats:styled-content>$325 (95%<jats:styled-content style=\"fixed-case\">CI US<\/jats:styled-content>$322 \u2010 <jats:styled-content style=\"fixed-case\">US<\/jats:styled-content>$328) per patient for strategy 3. Future diagnostic strategies can cost up to these amounts per patient and still be cost saving. Annually, for the Netherlands, \u20ac2.8 to \u20ac3.2 million could be saved and \u20ac10.8 to \u20ac12.3 million for the <jats:styled-content style=\"fixed-case\">UK<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The model shows that substantial savings could be generated if it is possible to further optimise the diagnosis of <jats:styled-content style=\"fixed-case\">VS<\/jats:styled-content>.<\/jats:p><\/jats:sec>","DOI":"10.1111\/coa.12973","type":"journal-article","created":{"date-parts":[[2017,8,18]],"date-time":"2017-08-18T14:46:36Z","timestamp":1503067596000},"page":"285-290","source":"Crossref","is-referenced-by-count":5,"title":["Potential savings in the diagnosis of vestibular schwannoma"],"prefix":"10.1111","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3102-6011","authenticated-orcid":false,"given":"M.","family":"Scholte","sequence":"first","affiliation":[{"name":"Department of Operating Rooms Radboud Institute of Health Sciences Radboud University Medical Center Nijmegen The\u00a0Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6106-089X","authenticated-orcid":false,"given":"M.A.","family":"Hentschel","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Radboud Institute of Health Sciences Radboud University Medical Center Nijmegen The\u00a0Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1162-6394","authenticated-orcid":false,"given":"H.P.","family":"Kunst","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Radboud Institute of Health Sciences Radboud University Medical Center Nijmegen The\u00a0Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8580-4726","authenticated-orcid":false,"given":"S.C.A.","family":"Steens","sequence":"additional","affiliation":[{"name":"Department of Radiology and Nuclear Medicine Radboud University Medical Center Nijmegen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3095-170X","authenticated-orcid":false,"given":"M.M.","family":"Rovers","sequence":"additional","affiliation":[{"name":"Department of Operating Rooms Radboud Institute of Health Sciences Radboud University Medical Center Nijmegen The\u00a0Netherlands"},{"name":"Department of Health Evidence Radboud Institute of Health Sciences Radboud University Medical Center Nijmegen The\u00a0Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2579-1561","authenticated-orcid":false,"given":"J.P.C.","family":"Grutters","sequence":"additional","affiliation":[{"name":"Department of Operating Rooms Radboud Institute of Health Sciences Radboud University Medical Center Nijmegen The\u00a0Netherlands"},{"name":"Department of Health Evidence Radboud Institute of Health Sciences Radboud University Medical Center Nijmegen The\u00a0Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,9,7]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.3310\/hta13180"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/archotol.131.3.241"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1227\/NEU.0b013e3181f22660"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006123-199701000-00001"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.150.6.1371"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.crad.2010.10.016"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1258\/0022215001906462"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.324.7342.859"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.f4247"},{"key":"e_1_2_8_11_1","unstructured":"Zorginstituut Nederland. 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