Cost-effective diagnosis of acoustic neuromas: a philosophical, macroeconomic, and technological decision.

Abstract

Our goals were to define the most sensitive techniques of acoustic neuroma diagnosis, to examine their relative costs, and to propose diagnostic modality selection given the rarity of acoustic neuroma incidence and given the other costs that society faces in more commonly encountered diseases. We conducted a MEDLINE search of the English language from 1966 to 2001 using the following keywords: acoustic neuroma, acoustic tumor, vestibular schwannoma, diagnosis, cost effectiveness, MRI, auditory brainstem response, brainstem audiometric evoked response, incidence, and prevalence. Although magnetic resonance imaging with gadolinium remains the most sensitive diagnostic modality in the discovery of acoustic neuromas, its cost may be prohibitive for some societies. Which modality to use in acoustic neuroma diagnosis is just as much a philosophical and macroeconomic question as a technological one. The cost of a timely diagnosis of acoustic neuromas must be weighed against using resources for other, more pressing, health concerns.