Cost-effectiveness of magnetic resonance imaging of the knee for patients presenting in primary care

Andronis, Lazaros, Atwell, Christine, Brealey, Stephen, Bryan, Stirling, Collins, Sue, Cox, Helen, Cross, Ben, Coulton, Simon, Fylan, Fiona, Garratt, Andrew, Gilbert, Fiona, Gillan, Maureen, Hendry, Maggie ORCID: https://orcid.org/0000-0002-6436-7771, Hood, Kerenza ORCID: https://orcid.org/0000-0002-5268-8631, Houston, Helen Louise Ann, King, David, Morton, Veronica, Orchard, Jo, Robling, Michael Richard ORCID: https://orcid.org/0000-0002-1004-036X, Russell, Ian, Torgerson, David, Wadsworth, Val and Wilkinson, Clare Elizabeth 2008. Cost-effectiveness of magnetic resonance imaging of the knee for patients presenting in primary care. British Journal of General Practice 58 (556) , e10-e16. 10.3399/bjgp08X342660

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Abstract

Background: Musculoskeletal problems generate high costs. Of these disorders, patients with knee problems are commonly seen by GPs. Magnetic resonance imaging (MRI) of the knee is an accurate diagnostic test, but there is uncertainty as to whether GP access to MRI for these patients is a cost-effective policy. Aim: To investigate the cost-effectiveness of GP referral to early MRI and a provisional orthopaedic appointment, compared with referral to an orthopaedic specialist without prior MRI for patients with continuing knee problems. Design of study: Cost-effectiveness analysis alongside a pragmatic randomised trial. Setting: Five-hundred and thirty-three patients consulting their GP about a knee problem were recruited from 163 general practices at 11 sites across the UK. Method: Two-year costs were estimated from the NHS perspective. Health outcomes were expressed in terms of quality-adjusted life years (QALYs), based on patient responses to the EQ-5D questionnaire administered at baseline, and at 6, 12, and 24 months' follow-up. Results: Early MRI is associated with a higher NHS cost, by £294 ($581; €435) per patient (95% confidence interval [CI] = £31 to £573), and a larger number of QALYs, by 0.05 (95% CI = 0.025 to 0.118). Mean differences in cost and QALYs generated an incremental cost per QALY gained of £5840 ($11 538; €8642). At a cost per QALY threshold of £20 000, there is a 0.81 probability that early MRI is a cost-effective use of NHS resources. Conclusion: GP access to MRI for patients presenting in primary care with a continuing knee problem represents a cost-effective use of health service resources.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Medicine
Subjects:	R Medicine > R Medicine (General) R Medicine > RA Public aspects of medicine
Uncontrolled Keywords:	cost-benefit analysis, family practice, knee injuries, magnetic resonance imaging
Additional Information:	Authors are members of DAMASK Direct Access to Magnetic Resonance Imaging Assessment for Suspect Knees Trial Team.
Publisher:	Royal College of General Practitioners
ISSN:	0960-1643
Last Modified:	06 Jul 2023 01:35
URI:	https://orca.cardiff.ac.uk/id/eprint/29490

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