TY - JOUR
T1 - General practitioners referring adults to MR imaging for knee pain
T2 - A randomized controlled trial to assess cost-effectiveness
AU - Van Oudenaarde, Kim
AU - Swart, Nynke M.
AU - Bloem, Johan L.
AU - Bierma-Zeinstra, Sita M.A.
AU - Algra, Paul R.
AU - Bindels, Patrick J.E.
AU - Koes, Bart W.
AU - Nelissen, Rob G.H.H.
AU - Verhaar, Jan A.N.
AU - Luijsterburg, Pim A.J.
AU - Reijnierse, Monique
AU - Van Den Hout, Wilbert B.
N1 - Funding Information: Supported by ZonMw (171202005). Publisher Copyright: © RSNA, 2018.
PY - 2018/7
Y1 - 2018/7
N2 - Purpose: To determine the cost-effectiveness of early referral by the general practitioner for magnetic resonance (MR) imaging compared with usual care alone in patients aged 18-45 years with traumatic knee symptoms. Materials and Methods: Cost-utility analysis was performed parallel to a prospective multicenter randomized controlled trial in Dutch general practice. A total of 356 patients with traumatic knee symptoms were included from November 2012 to December 2015 (mean age, 33 years ± 8 [standard deviation]; 222 men [62%]). Patients were randomly assigned to usual care (n = 177; MR imaging was not performed, but patients were referred to an orthopedic surgeon when conservative treatment was unsatisfactory) or MR imaging (n = 179) within 2 weeks after injury. Main outcome measures were quality-adjusted life years (QALYs) and costs from a healthcare and societal perspective. Multiple imputation was used for missing data. The Student t test was used to assess differences in mean QALYs, costs, and net benefits. Results: Mean QALYs were 0.888 in the MR imaging group and 0.899 in the usual care group (P = .255). Healthcare costs per patient were higher in the MR imaging group (€1109) than in the usual care group (€837) (P = .050), mainly due to higher costs for MR imaging, with no reduction in the number of referrals to an orthopedic surgeon in the MR imaging group. Conclusion: MR imaging referral by the general practitioner was not cost-effective in patients with traumatic knee symptoms; in fact, MR imaging led to more healthcare costs, without an improvement in health outcomes.
AB - Purpose: To determine the cost-effectiveness of early referral by the general practitioner for magnetic resonance (MR) imaging compared with usual care alone in patients aged 18-45 years with traumatic knee symptoms. Materials and Methods: Cost-utility analysis was performed parallel to a prospective multicenter randomized controlled trial in Dutch general practice. A total of 356 patients with traumatic knee symptoms were included from November 2012 to December 2015 (mean age, 33 years ± 8 [standard deviation]; 222 men [62%]). Patients were randomly assigned to usual care (n = 177; MR imaging was not performed, but patients were referred to an orthopedic surgeon when conservative treatment was unsatisfactory) or MR imaging (n = 179) within 2 weeks after injury. Main outcome measures were quality-adjusted life years (QALYs) and costs from a healthcare and societal perspective. Multiple imputation was used for missing data. The Student t test was used to assess differences in mean QALYs, costs, and net benefits. Results: Mean QALYs were 0.888 in the MR imaging group and 0.899 in the usual care group (P = .255). Healthcare costs per patient were higher in the MR imaging group (€1109) than in the usual care group (€837) (P = .050), mainly due to higher costs for MR imaging, with no reduction in the number of referrals to an orthopedic surgeon in the MR imaging group. Conclusion: MR imaging referral by the general practitioner was not cost-effective in patients with traumatic knee symptoms; in fact, MR imaging led to more healthcare costs, without an improvement in health outcomes.
UR - http://www.scopus.com/inward/record.url?scp=85050274928&partnerID=8YFLogxK
U2 - https://doi.org/10.1148/radiol.2018171383
DO - https://doi.org/10.1148/radiol.2018171383
M3 - Article
C2 - 29664339
SN - 0033-8419
VL - 288
SP - 170
EP - 176
JO - Radiology
JF - Radiology
IS - 1
ER -