Sahar Jalali Farahani MBBS, Presenter: Nothing to Disclose

John Eng MD, Abstract Co-Author: Nothing to Disclose

John A. Carrino MD, MPH, Abstract Co-Author: Consultant, BioClinica, Inc Consultant, Pfizer Inc Advisory Board, General Electric Company

Shadpour Demehri MD, Abstract Co-Author: Nothing to Disclose

To evaluate the cost effectiveness of performing 3T MRI in patients with chronic wrist pain

 A decision analysis model was designed to compare the following diagnostic algorithms in the patients with chronic wrist pain (> 3 months): (1) 3T MRI followed by diagnostic arthroscopy for positive findings; and (2) Diagnostic arthroscopy.  The assumption was the detected injuries were treatable by surgical repair or therapeutic arthroscopy. Short-term and long-term outcome were considered as unnecessary arthroscopy avoided and Quality-Adjusted-Life (QALY), respectively. Costs from societal perspective and incremental cost to effectiveness ratio were calculated. Accuracy of MRI in detection of wrist injuries, utility loss due to wrist pain and costs associated with each strategy were estimated from literature and Medicare reimbursement data for 2013. The willingness-to-pay threshold was considered to be $50000. Sensitivity analysis was conducted to examine the model’s stability to variations in the clinically plausible range of the model's variables.  

Sensitivity and specificity of MRI was considered as 74% and 84%, respectively. The prevalence of ligamentous injuries in the study population was considered as 25%. The analysis showed that using MRI as the primary indicator of necessity of performing arthroscopy cost average of $1425 per patient, while performing arthroscopy in all patients cost $2500 per patient. The incremental cost of using MRI to avoid one unnecessary arthroscopy was estimated as $793. The incremental costs of performing non-selective arthroscopy in all the patients in comparison to using MRI was $82692 per one QALY gained. Considering a subgroup of patients whose ligamentous injury is not amenable by arthroscopy, this amount decreased to $8035. The sensitivity analysis showed the model was stable to variation in clinically plausible ranges of 3T MRI sensitivity and specificity, providing prevalence of repairable wrist injury between the patients with chronic wrist pain did not exceed 34%.  

Performing 3T MRI to determine the necessity of diagnostic arthroscopy in patients with chronic wrist pain may be cost-effective.

 In practices where most patients with wrist pain require no arthrosopic repair; MRI may be cost-effective both in avoiding unnecessary diagnostic arthroscopy and long-term societal perspective.

Farahani, S, Eng, J, Carrino, J, Demehri, S, Cost-effectiveness Analysis of Utilizing 3T MRI to Select Which Patients with Chronic Wrist Pain Should Undergo Arthroscopy.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14013934.html