Economic efficiency of low-dose wholebody X-ray computed tomography in the diagnosis of skeletal lesions in multiple myeloma

Skeletal radiography remains the primary imaging method for multiple myeloma (MM) included in the clinical protocol of the Republic of Belarus, but its low sensitivity increases the risk of false–negative results and delayed therapy initiation, which is associated with additional costs of treating progressive disease.Objective: to evaluate the economic efficiency of whole–body low–dose computed tomography (LDCT) compared with skeletal radiography in patients with MM.The study included 189 patients: 131 with confirmed MM (main group) and 58 with monoclonal gammopathy (comparison group), all of whom underwent whole–body LDCT. Economic efficiency of LDCT versus skeletal radiography was assessed using methodologies of the Ministry of Health of the Republic of Belarus: direct unit and annual cost savings, a costeffectiveness ratio, and a medical efficacy coefficient (Km) were calculated.A full skeletal radiography protocol includes 17–23 images, takes 60-90 minutes, and requires 15,6 conventional staff time units; whole–body LDCT is performed as a single 8–12 min study requiring 7,0 conventional time units. Whole-body LDCT outperforms skeletal radiography in diagnostic accuracy (sensitivity 78,6% vs ~50% per the literature) and economically justified compared with skeletal radiography: it provides higher medical efficacy (Km 0,61 vs 0,22), a 5,86–fold lower cost per unit of medical effect, a 55,1% reduction in staff workload, and an approximately 7,5–fold reduction in examination time, along with avoidance of costs associated with treating advanced MM complications. Timely detection of MM complications by LDCT was noted in 62 MM patients (47,3%), and clinically significant comorbidity in 69 MM patients (52,7%).