Objective: To compare the cost-effectiveness of serial non-echo planar diffusion weighted MRI (non-EP DW MRI) versus planned second look surgery following initial canal wall up tympanomastoidectomy for the treatment of cholesteatoma.
Methods: A decision-analytic model was developed. Model inputs including residual cholesteatoma rates, rates of non-EP DW MRI positivity after surgery, and health utility scores were abstracted from published literature. Cost data were derived from the 2022 Centers for Medicare and Medicaid Services fee rates. Efficacy was defined as increase in quality-adjusted life year (QALY). One- and 2-way sensitivity analyses were performed on variables of interest to probe the model. Total time horizon was 50 years with a willingness to pay (WTP) threshold set at $50 000/QALY.
Results: Base case analysis revealed that planned second-look surgery ($11 537, 17.30 QALY) and imaging surveillance with non-EP DWMRI ($10 439, 17.26 QALY) were both cost effective options. Incremental cost effectiveness ratio was $27 298/QALY, which is below the WTP threhshold. One-way sensitivity analyses showed that non-EP DW MRI was more cost effective than planned second-look surgery if the rate of residual disease after surgery increased to 48.3% or if the rate of positive MRI was below 45.9%. A probabilistic sensitivity analysis at WTP of $50 000/QALY found that second-look surgery was more cost-effective in 56.7% of iterations.
Conclusion: Non-EP DW MRI surveillance is a cost-effect alternative to planned second-look surgery following primary canal wall up tympanomastoidectomy for cholesteatoma. Cholesteatoma surveillance decisions after initial canal wall up tympanomastoidectomy should be individualized.
Level Of Evidence: V.
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http://dx.doi.org/10.1177/00034894241250253 | DOI Listing |
Diagnostics (Basel)
January 2025
Research Center on Thromboembolic Diseases and Antithrombotic Treatment, Department of Medicine and Surgery, University of Insubria, 21100 Varese, Italy.
Deep venous thrombosis (DVT) is a pathological condition that develops when a thrombus forms within the deep venous system. Typically, it involves the lower limbs and, less frequently, the upper extremities or other unusual districts such as cerebral or splanchnic veins. While leg DVT itself is rarely fatal and occasionally can lead to limb-threatening implications, its most fearsome complication, namely pulmonary embolism, is potentially fatal and significantly contributes to increased healthcare costs and impaired quality of life in affected patients and caregivers.
View Article and Find Full Text PDFJ Neuroophthalmol
January 2025
Scheie Eye Institute (YC, TL, SW, TP, PAA, G-sY, CAB, MAT), University of Pennsylvania, Philadelphia, Pennsylvania; Divisions of Neuro-ophthalmology (MAT), Oculoplastics (CAB), and Biostatistics (PAA, G-sY), Kansas Health Science Center, Kansas College of Osteopathic Medicine; and Kansas Health Science Center (GM), Kansas College of Osteopathic Medicine, Kansas, Missouri.
Background: To characterize the retreatment course of patients with thyroid eye disease (TED), who had reactivation after initial therapy with teprotumumab.
Methods: This was a single-center longitudinal cohort study of patients who received an initial course of teprotumumab for active TED and were followed for at least 6 months. Reactivation was defined as the increase of proptosis of 2 mm or more or an increase in Clinical Activity Score (CAS) of two points or more, as adapted from the Optic-X study.
J Knee Surg
January 2025
Department of Orthopaedic Surgery, Pohang St. Mary's Hospital, Nam-gu, Pohang-si, Gyeongsangbuk-do, Republic of Korea.
This study aimed to compare clinical outcomes and second-look arthroscopic findings between double-bundle anterior cruciate ligament (ACL) reconstruction for complete ACL rupture and anteromedial (AM) bundle augmentation with preservation of the posterolateral (PL) bundle in isolated AM bundle rupture. Between 2014 and 2021, we retrospectively analyzed 95 ACL reconstructions with at least 2 years of follow-up. Patients undergoing primary ACL reconstruction from January 2014 to June 2021 were included in the study.
View Article and Find Full Text PDFAm J Sports Med
January 2025
Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA.
Background: Mismatch between osteochondral allograft (OCA) donor and recipient sex has been shown to negatively affect outcomes. This study accounts for additional donor variables and clinically relevant outcomes.
Purpose: To evaluate whether donor sex, age, donor-recipient sex mismatch, and duration of graft storage affect clinical outcomes and failure rates after knee OCA transplantation.
Am J Sports Med
January 2025
Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.
Background: Knee injuries resulting in purely cartilaginous defects are rare, and controversy remains regarding the reliability of chondral-only fixation.
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Study Design: Systematic review; Level of evidence, 5.
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