One image-guided approach to treating osteoid osteoma is significantly more expensive than alternatives, interventional radiologists warned in analysis published Tuesday.

These painful, benign skeletal tumors typically occur in the long bones, with physicians frequently prescribing nonsteroidal anti-inflammatory medications as a first-line response. Minimally invasive approaches such as image-guided ablation to heat up and destroy the tumor are preferred as a next step over surgery. Outcomes are similar between the different imaging modalities and ablation technology, but costs are not, experts detailed in the Journal of the American College of Radiology.

In particular, cone beam CT-guided ablation costs about 8% or nearly $437 more than using traditional computed tomography. Meanwhile, utilizing radiofrequencies to destroy the tumor costs about $307 or 5.4% more than microwave ablation, after controlling for factors such as patient positioning and imaging modality.

“The use of cone beam CT with overlay fluoroscopic guidance for osteoid osteoma ablation resulted in longer in-room times and greater cost when compared to conventional CT,” lead author Joseph Reis, MD, with the Department of Radiology at Seattle Children’s Hospital, and co-authors concluded. “These cost considerations should be weighed against potential radiation dose advantage of CBCT when choosing an image guidance modality.”

To reach their conclusions, researchers retrospectively analyzed all patients who underwent osteoid osteoma ablation at their institution over the 11 years ending in March 2022. They performed a time-driven, activity-based cost analysis for payment rate-dependent variables such as salaries, equipment depreciation, room time and certain supplies. Other time-independent costs included disposable supplies and different ablation systems, the authors noted.

All told, 91 patients underwent 96 ablation procedures during the study’s timeframe, including 66 using costlier cone beam CT and the other 30 utilizing conventional CT. Cases were split close to evenly between the more expensive radiofrequency (45) and microwave (51) ablation approaches. Reis and co-authors found that anesthesia induction (+22.7 minutes), procedure (+64.7 minutes) and room (+137.7 minutes) times were all significantly longer for CBCT, with no difference between ablation methods. Further analysis demonstrated that lower patient age, CBCT use, radiofrequency ablation, and placing the subject in a nonsupine position all significantly increased costs.

“Improvement in outcome measures such as radiation dose are always coexisting goals in [time-driven activity-based costing],” the authors advised. “The definition of value in this model is health outcomes per dollar spent. Radiation dose has consistently been shown to be lower for CBCT compared with [conventional computed tomography] for [osteoid osteoma] ablation and spinal bone biopsies, suggesting a relative advantage. The degree to which CBCT lowers dose will require ongoing evaluation given that low-dose algorithms have historically been variable and constantly evolving.”

Read much more, including potential study limitations, in JACR at the link below.