Our decision-analytic model examined the cost-effectiveness of MR Spectroscopy (MRS), MR perfusion (MRP), and the combination of MRS, MRP and DWI for differentiating brain radiation necrosis from tumor progression in high-risk low-grade glioma. Our results suggested that performing combined imaging method had good diagnostic accuracy for a 3-year time horizon but not a cost-effective in the long run. In contrast, MRS and especially MRP alone were more cost-effective over all time horizons. MRS is the most cost-effective method in lifetime when its negative predictive value≥88% at the Willingness-to-Pay threshold of $100,000.
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