2026-04-17T12:13:04Zhttps://recercat.cat/oai/request

oai:recercat.cat:2445/1758592025-12-04T20:39:54Zcom_2072_1057col_2072_478800col_2072_478917

00925njm 22002777a 4500 dc García García, Sergio author García Lorenzo, Borja author Roldán Ramos, Pedro author González Sánchez, José Juan author Culebras, Diego author Restovic, Gabriela author Alcover, Estanis author Pons, Imma author Torales, Jorge author Reyes, Luis author Sampietro Colom, Laura author Enseñat Nora, Joaquim author 2021-03-29T14:12:56Z 2021-03-29T14:12:56Z 2020-11-02 2021-03-29T14:12:56Z Object: Low-field intraoperative magnetic resonance (LF-iMR) has demonstrated a slight increase in the extent of resection of intra-axial tumors while preserving patient`s neurological outcomes. However, whether this improvement is cost-effective or not is still matter of controversy. In this clinical investigation we sought to evaluate the cost-effectiveness of the implementation of a LF-iMR in glioma surgery. Methods: Patients undergoing LF-iMR guided glioma surgery with gross total resection (GTR) intention were prospectively collected and compared to an historical cohort operated without this technology. Socio-demographic and clinical variables (pre and postoperative KPS; histopathological classification; Extent of resection; postoperative complications; need of re-intervention within the first year and 1-year postoperative survival) were collected and analyzed. Effectiveness variables were assessed in both groups: Postoperative Karnofsky performance status scale (pKPS); overall survival (OS); Progression-free survival (PFS); and a variable accounting for the number of patients with a greater than subtotal resection and same or higher postoperative KPS (R-KPS). All preoperative, procedural and postoperative costs linked to the treatment were considered for the cost-effectiveness analysis (diagnostic procedures, prosthesis, operating time, hospitalization, consumables, LF-iMR device, etc). Deterministic and probabilistic simulations were conducted to evaluate the consistency of our analysis. Results: 50 patients were operated with LF-iMR assistance, while 146 belonged to the control group. GTR rate, pKPS, R-KPS, PFS, and 1-year OS were respectively 13,8% (not significative), 7 points (p < 0.05), 17% (p < 0.05), 38 days (p < 0.05), and 3.7% (not significative) higher in the intervention group. Cost-effectiveness analysis showed a mean incremental cost per patient of 789 in the intervention group. Incremental cost-effectiveness ratios were 111 per additional point of pKPS, 21 per additional day free of progression, and 46 per additional percentage point of R-KPS. Conclusion: Glioma patients operated under LF-iMR guidance experience a better functional outcome, higher resection rates, less complications, better PFS rates but similar life expectancy compared to conventional techniques. In terms of efficiency, LF-iMR is very close to be a dominant technology in terms of R-KPS, PFS and pKPS. Glioma Ressonància magnètica Gliomas Magnetic resonance Cost-Effectiveness of Low-Field Intraoperative Magnetic Resonance in Glioma Surgery