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J Shoulder Elbow Surg. 2017 Dec;26(12):2067-2077. doi: 10.1016/j.jse.2017.07.012. Epub 2017 Sep 8.

Cost-effectiveness of magnetic resonance imaging versus ultrasound for the detection of symptomatic full-thickness supraspinatus tendon tears.

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Department of Radiology, NYU Langone Medical Center/Hospital for Joint Diseases, New York, NY, USA. Electronic address:
Stony Brook University Medical Center, Stony Brook, NY, USA.
Department of Radiology, Cleveland Clinic, Cleveland, OH, USA.
Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, USA.
Department of Population Health and Orthopaedic Surgery, NYU School of Medicine, New York, NY, USA.



The purpose of this study was to determine the value of magnetic resonance imaging (MRI) and ultrasound-based imaging strategies in the evaluation of a hypothetical population with a symptomatic full-thickness supraspinatus tendon (FTST) tear using formal cost-effectiveness analysis.


A decision analytic model from the health care system perspective for 60-year-old patients with symptoms secondary to a suspected FTST tear was used to evaluate the incremental cost-effectiveness of 3 imaging strategies during a 2-year time horizon: MRI, ultrasound, and ultrasound followed by MRI. Comprehensive literature search and expert opinion provided data on cost, probability, and quality of life estimates. The primary effectiveness outcome was quality-adjusted life-years (QALYs) through 2 years, with a willingness-to-pay threshold set to $100,000/QALY gained (2016 U.S. dollars). Costs and health benefits were discounted at 3%.


Ultrasound was the least costly strategy ($1385). MRI was the most effective (1.332 QALYs). Ultrasound was the most cost-effective strategy but was not dominant. The incremental cost-effectiveness ratio for MRI was $22,756/QALY gained, below the willingness-to-pay threshold. Two-way sensitivity analysis demonstrated that MRI was favored over the other imaging strategies over a wide range of reasonable costs. In probabilistic sensitivity analysis, MRI was the preferred imaging strategy in 78% of the simulations.


MRI and ultrasound represent cost-effective imaging options for evaluation of the patient thought to have a symptomatic FTST tear. The results indicate that MRI is the preferred strategy based on cost-effectiveness criteria, although the decision between MRI and ultrasound for an imaging center is likely to be dependent on additional factors, such as available resources and workflow.


Cost-effectiveness; MRI; comparative effectiveness; rotator cuff; rotator cuff imaging; ultrasound

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