The cost-effectiveness of MRI of the knee for patients presenting in primary care

L. Andronis, S. Bryan, C. Atwell, S. D. Brealey, S. Coulton, H. Cox, B. Cross, F. Fylan, A. M. Garratt, Fiona Jane Gilbert, Maureen Grace Charles Gillan, M. Hendry, K. Hood, H. Houston, D. King, V. Morton, J. Orchard, M. Robling, I. T. Russell, D. TorgersonV. Wadsworth, C. Wilkinson, DAMASK Trial Team

Research output: Contribution to journalArticle

13 Citations (Scopus)

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 (OALYs), 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 pound ($581; is an element of 435) per patient (95% confidence interval [CI] = 31 pound to 2573), 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 OALY gained of 25840 ($11 538; is an element of 8642). At a cost per QALY threshold of 920 000, 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.

Original languageEnglish
Pages (from-to)775-778
Number of pages3
JournalThe British Journal of General Practice
Volume58
Issue number556
DOIs
Publication statusPublished - Nov 2008

Keywords

  • cost-benefit analysis
  • family practice
  • knee injuries
  • magnetic resonance imaging

Cite this

Andronis, L., Bryan, S., Atwell, C., Brealey, S. D., Coulton, S., Cox, H., ... DAMASK Trial Team (2008). The cost-effectiveness of MRI of the knee for patients presenting in primary care. The British Journal of General Practice, 58(556), 775-778. https://doi.org/10.3399/bjgp08X342660

The cost-effectiveness of MRI of the knee for patients presenting in primary care. / Andronis, L.; Bryan, S.; Atwell, C.; Brealey, S. D.; Coulton, S.; Cox, H.; Cross, B.; Fylan, F.; Garratt, A. M.; Gilbert, Fiona Jane; Gillan, Maureen Grace Charles; Hendry, M.; Hood, K.; Houston, H.; King, D.; Morton, V.; Orchard, J.; Robling, M.; Russell, I. T.; Torgerson, D.; Wadsworth, V.; Wilkinson, C.; DAMASK Trial Team.

In: The British Journal of General Practice, Vol. 58, No. 556, 11.2008, p. 775-778.

Research output: Contribution to journalArticle

Andronis, L, Bryan, S, Atwell, C, Brealey, SD, Coulton, S, Cox, H, Cross, B, Fylan, F, Garratt, AM, Gilbert, FJ, Gillan, MGC, Hendry, M, Hood, K, Houston, H, King, D, Morton, V, Orchard, J, Robling, M, Russell, IT, Torgerson, D, Wadsworth, V, Wilkinson, C & DAMASK Trial Team 2008, 'The cost-effectiveness of MRI of the knee for patients presenting in primary care', The British Journal of General Practice, vol. 58, no. 556, pp. 775-778. https://doi.org/10.3399/bjgp08X342660
Andronis, L. ; Bryan, S. ; Atwell, C. ; Brealey, S. D. ; Coulton, S. ; Cox, H. ; Cross, B. ; Fylan, F. ; Garratt, A. M. ; Gilbert, Fiona Jane ; Gillan, Maureen Grace Charles ; Hendry, M. ; Hood, K. ; Houston, H. ; King, D. ; Morton, V. ; Orchard, J. ; Robling, M. ; Russell, I. T. ; Torgerson, D. ; Wadsworth, V. ; Wilkinson, C. ; DAMASK Trial Team. / The cost-effectiveness of MRI of the knee for patients presenting in primary care. In: The British Journal of General Practice. 2008 ; Vol. 58, No. 556. pp. 775-778.
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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 (OALYs), 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 pound ($581; is an element of 435) per patient (95{\%} confidence interval [CI] = 31 pound to 2573), 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 OALY gained of 25840 ($11 538; is an element of 8642). At a cost per QALY threshold of 920 000, 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.",
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author = "L. Andronis and S. Bryan and C. Atwell and Brealey, {S. D.} and S. Coulton and H. Cox and B. Cross and F. Fylan and Garratt, {A. M.} and Gilbert, {Fiona Jane} and Gillan, {Maureen Grace Charles} and M. Hendry and K. Hood and H. Houston and D. King and V. Morton and J. Orchard and M. Robling and Russell, {I. T.} and D. Torgerson and V. Wadsworth and C. Wilkinson and {DAMASK Trial Team}",
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TY - JOUR

T1 - The cost-effectiveness of MRI of the knee for patients presenting in primary care

AU - Andronis, L.

AU - Bryan, S.

AU - Atwell, C.

AU - Brealey, S. D.

AU - Coulton, S.

AU - Cox, H.

AU - Cross, B.

AU - Fylan, F.

AU - Garratt, A. M.

AU - Gilbert, Fiona Jane

AU - Gillan, Maureen Grace Charles

AU - Hendry, M.

AU - Hood, K.

AU - Houston, H.

AU - King, D.

AU - Morton, V.

AU - Orchard, J.

AU - Robling, M.

AU - Russell, I. T.

AU - Torgerson, D.

AU - Wadsworth, V.

AU - Wilkinson, C.

AU - DAMASK Trial Team

PY - 2008/11

Y1 - 2008/11

N2 - 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 (OALYs), 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 pound ($581; is an element of 435) per patient (95% confidence interval [CI] = 31 pound to 2573), 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 OALY gained of 25840 ($11 538; is an element of 8642). At a cost per QALY threshold of 920 000, 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.

AB - 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 (OALYs), 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 pound ($581; is an element of 435) per patient (95% confidence interval [CI] = 31 pound to 2573), 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 OALY gained of 25840 ($11 538; is an element of 8642). At a cost per QALY threshold of 920 000, 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.

KW - cost-benefit analysis

KW - family practice

KW - knee injuries

KW - magnetic resonance imaging

U2 - 10.3399/bjgp08X342660

DO - 10.3399/bjgp08X342660

M3 - Article

VL - 58

SP - 775

EP - 778

JO - The British Journal of General Practice

JF - The British Journal of General Practice

SN - 0960-1643

IS - 556

ER -