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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.

Author information

1
Department of Radiology, NYU Langone Medical Center/Hospital for Joint Diseases, New York, NY, USA. Electronic address: Soterios20@gmail.com.
2
Stony Brook University Medical Center, Stony Brook, NY, USA.
3
Department of Radiology, Cleveland Clinic, Cleveland, OH, USA.
4
Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY, USA.
5
Department of Population Health and Orthopaedic Surgery, NYU School of Medicine, New York, NY, USA.

Abstract

BACKGROUND:

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.

METHODS:

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%.

RESULTS:

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.

CONCLUSION:

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.

KEYWORDS:

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

PMID:
28893546
DOI:
10.1016/j.jse.2017.07.012
[Indexed for MEDLINE]

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