Rapid Magnetic Resonance Imaging for ... - Wiley Online Library

6 downloads 9691 Views 911KB Size Report
of LBP (e.g., herniated discs, spinal stenosis) and considered only .... recover normal (18%) or assisted (11%) gait.43 If cord ..... Health Services Research.
JGIM

REVIEW

Rapid Magnetic Resonance Imaging for Diagnosing Cancer-related Low Back Pain A Cost-effectiveness Analysis William Hollingworth, PhD, Darryl T. Gray, MD, ScD, Brook I. Martin, BS, Sean D. Sullivan, PhD, Richard A. Deyo, MD, MPH, Jeffrey G. Jarvik, MD, MPH

OBJECTIVES: This study compared the relative efficiency of lumbar x-ray and rapid magnetic resonance (MR) imaging for diagnosing cancer-related low back pain (LBP) in primary care patients. DESIGN: We developed a decision model with Markov state transitions to calculate the cost per case detected and cost per quality-adjusted life year (QALY) of rapid MR imaging. Model parameters were estimated from the medical literature. The costs of x-ray and rapid MR were calculated in an activitybased costing study. SETTING AND PATIENTS: A hypothetical cohort of primary care patients with LBP referred for imaging to exclude cancer as the cause of their pain. MAIN RESULTS: The rapid MR strategy was more expensive due to higher initial imaging costs and larger numbers of patients requiring conventional MR and biopsy. The overall sensitivity of the rapid MR strategy was higher than that of the x-ray strategy (62% vs 55%). However, because of low preimaging prevalence of cancer-related LBP, this generates