Hostname: page-component-7479d7b7d-rvbq7 Total loading time: 0 Render date: 2024-07-09T02:27:15.193Z Has data issue: false hasContentIssue false

The Cost-Effectiveness of Magnetic Resonance Imaging for Patients with Equivocal Neurological Symptoms

Published online by Cambridge University Press:  10 March 2009

Alvin I. Mushlin
Affiliation:
University of Rochester
Cathleen Mooney
Affiliation:
University of Rochester
Robert G. Holloway
Affiliation:
University of Rochester
Allan S. Detsky
Affiliation:
University of Toronto
David H. Mattson
Affiliation:
University of Rochester
Charles E. Phelps
Affiliation:
University of Rochester

Abstract

Objective: To determine the incremental cost-effectiveness of magnetic resonance imaging (MRI) and computed tomography (CT) in young adults presenting with equivocal neurological signs and symptoms. Designs and methods: A decision analysis of long-term survival using accuracy data from a diagnostic technology assessment of MRI and CT in patients with suspected multiple sclerosis, information from the medical literature, and clinical assumptions. Main results: In the baseline analysis, at 30% likelihood of an underlying neurologic disease, MRI use has an incremental cost of $101,670 for each additional quality-adjusted life-year saved compared with $20,290 for CT use. As the probability of disease increases, further MRI use becomes a cost-effective alternative costing $30,000 for each quality-adjusted life-year saved. If a negative MRI result provides reassurance, the incremental costs of immediate MRI use decreases and falls below $25,000 for each quality-adjusted life-year saved no matter the likelihood of disease. Conclusions: For most individuals with neurological symptoms or signs, CT imaging is cost-effective while MR imaging is not. The cost-effectiveness of MRI use, however, improves as the likelihood of an underlying neurological disease increases. For selected patients who highly value diagnostic information, MRI is a reasonable and cost-effective use of medical resources when even the likelihood of disease is quite low (5%).

Type
General Essays
Copyright
Copyright © Cambridge University Press 1997

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Adams, R. D., & Victor, M. Intracranial neoplasms. In Principles of neurology, 4th ed.New York: McGraw-Hill, 1989, 516–53.Google Scholar
2.Asch, A. D., & Hershey, J. C.Why some health policies don’t make sense at the bedside. Annals of Internal Medicine, 1995, 122, 846–50.CrossRefGoogle ScholarPubMed
3.Asch, A. D., Patton, J. P., & Hershey, J. C.Knowing for the sake of knowing: The value of prognostic information. Journal of Medical Decision Making, 1990, 10, 4757.Google Scholar
4.Ausman, J. I., French, L. A., & Baker, A. B. Intracranial neoplasms. In Joynt, R. J. (ed.) Clinical Neurology: Philadelphia, J. B. Lippincott; 1989.Google Scholar
5.Baldor, R. A., Quirk, M. E., & Dohan, D.Magnetic resonance imaging use by primary care physicians. Journal of Family Practice, 1993, 36, 281–85.Google ScholarPubMed
6.Bary, M. J., Mullery, A. G. Jr., Fowler, , & Wennberg, J. W.Watchful waiting vs. immediate transurethral resection for symptomatic prostatism: The importance of patients' preferences. Journal of the American Medical Association, 1988, 259, 30100–107.Google Scholar
7.Bautz, J. B., Schectman, J. M., Elinsky, E. G., et al. Magnetic resonance imaging: Diffusion of technology in an ambulatory setting. International Journal of Technology Assessment in Health Care, 1992, 8, 30.Google Scholar
8.Berwick, D. M., & Weinstein, M. C.What do patients value? Willingness to pay for ultrasound in normal pregnancy. Medical Care, 1985, 23, 881–93.Google Scholar
9.Bogousslavskyt, J., & Regli, F.Ischemic stroke in adults younger than 30 years of age: Cause and prognosis. Archives of Neurology, 1987, 44, 479–82.Google Scholar
10.Boutwell, R. C., & Mitchell, J. B.Diffusion of new technologies in the treatment of the Medicare population: Implications for patient access and program expenditures. International Journal of Technology Assessment in Health Care, 1993, 9, 6275.Google Scholar
11.Boyd, N. F., Sutherland, H. J., Heasman, K. Z., et al. Whose utilities for decision analysis? Journal of Medical Decision Making, 1990, 10, 5867.Google Scholar
12.Cantor, S. B.Cost-effectiveness analysis, extended dominance, and ethics: A quantitative assessment. Journal of Medical Decision Making, 1994, 14, 259–65.CrossRefGoogle ScholarPubMed
13.Cooper, L. S., Chalmers, T. C., McCally, M., et al. The poor quality of early evaluations of magnetic resonance imaging. Journal of the American Medical Association, 1988, 259, 3277–80.Google Scholar
14.Doughty, A., Nash, S. I., & Gift, D. A.Deployment and utilization of MR imaging in Michigan: Observations of a statewide data base. Radiology, 1992, 185, 5361.CrossRefGoogle ScholarPubMed
15.Giang, D. W., Grow, V. M., Mooney, C., et al. Clinical diagnosis of multiple sclerosis: The impact of magnetic resonance imaging and ancillary testing. Archives of Neurology, 1994, 51, 6166.CrossRefGoogle ScholarPubMed
16.Hart, R. G., & Miller, V. T.Cerebral infarction in young adults: A practical approach. Stroke, 1983, 14, 110–14.Google Scholar
17.Hillman, B. J.The assessment of MR imaging. American Journal of Roentgenology, 1988, 151, 858–60.Google Scholar
18.Horm, J. W., Asire, A. J., Young, J. L., et al. (eds.). SEER program: Cancer incidence and mortality in the United States 1973–1981. DHHS Publication No. (NIH) 85–1837. Bethesda: National Cancer Institute, 1984.Google Scholar
19.The IFNB Multiple Sclerosis Study Group. Interferon beta-lb is effective in relapsing-remitting multiple sclerosis. Neurology, 1993, 43, 655–67.CrossRefGoogle Scholar
20.Kassirer, J. P.Incorporating patients’ preferences into medical decisions. New England Journal of Medicine, 1994, 330, 1895–96.CrossRefGoogle ScholarPubMed
21.Kent, D. L., Haynor, D. R.Longstreth, W. T., & Larson, E. B.The clinical efficacy of magnetic resonance imaging in neuroimaging. Annals of Internal Medicine, 1994, 120, 856–71.Google Scholar
22.Kent, D. L., & Larson, E. B.Magnetic resonance imaging of the brain and spine. Annals of Internal Medicine, 1988, 108, 402–24.Google Scholar
23.Malgrem, R., Dudley, J. P., Visscher, B., et al. Mortality in persons with multiple sclerosis in the Seattle and Los Angeles areas. Journal of American Medical Association, 1981, 246, 2042–45.Google Scholar
24.Marton, K. I., Sox, H. C., Alexander, J., & Duisenberg, C. E.Attitudes of patients toward diagnostic tests: The case of the upper gastrointestinal series roentgenogram. Journal of Medical Decision Making, 1982, 2, 439–48.Google Scholar
25.Matsumoto, N., Whisnant, J. P., Kurland, L. T., & Okazaki, H.Natural history of stroke in Rochester, Minnesota, 1955 through 1969: An extension of a previous study, 1945–1954. Stroke, 1973, 4, 2029.Google Scholar
26.McFarlin, D. E., & McFarland, H. F.Multiple sclerosis (second of two parts). New England Journal of Medicine, 1982, 307, 1246–51.Google Scholar
28.Mooney, C., Mushlin, A. I., & Phelps, C. E.Targeting assessments of magnetic resonance imaging in suspected multiple sclerosis. Journal of Medical Decision Making, 1990, 10, 7794.Google Scholar
27.McNeil, B. J., Wichselbaum, R., & Pauker, S. G.Fallacy of five-year survival in lung cancer. New England Journal of Medicine, 1978, 299, 1397–401.Google Scholar
29.Mushlin, A. I., Detsky, A. S., Phelps, C. E., et al. The accuracy of MRI in patients with suspected MS. Journal of the American Medical Association, 1993, 269, 3146–51.Google Scholar
30.Mushlin, A. I., Mooney, C., Grow, V., & Phelps, C. E.The value of diagnostic information to patients with suspected MS. Archives of Neurology, 1994, 51, 6772.Google Scholar
31.Nishioka, N., Torner, J. C., Graf, C. J., et al. Cooperative study of intracranial aneurysms and subarachnoid hemorrhage: A long term prognostic study, II: Ruptured intracranial aneurysms managed conservatively. Archives of Neurology, 1984, 41, 1142–46.CrossRefGoogle ScholarPubMed
32.O'Connor, P., Detsky, A. S., Tansey, C., Kucharczyk, W., & Rochester-Toronto MRI Study Group. Effect of diagnostic testing for multiple sclerosis on patient health perceptions. Archives of Neurology, 1994, 51, 4651.CrossRefGoogle ScholarPubMed
33.Pauker, S. G.Coronary artery surgery: The use of decision analysis. Annals of Internal Medicine, 1976, 85, 818.Google Scholar
34.Phelps, C. E., & Mooney, C. Variations in medical practice use: Causes and consequences. In Arnould, R. J., Rich, R. F., & White, W. D. (eds.), Competitive approaches to health care reform. Washington, DC: The Urban Institute Press, 1993.Google Scholar
35.Phelps, C. E., & Mushlin, A. I.Focusing technology assessment using medical decision theory. Journal of Medical Decision Making, 1988, 8, 279–89.Google Scholar
36.Rublee, D. A. Medical technology in Canada, Germany, and the United States. Health Affairs, 1989, Fall, 178–81.Google Scholar
37.Simon, D. G., & Lubin, M. F.Cost-effectiveness of computerized tomography and magnetic resonance imaging in dementia. Journal of Medical Decision Making, 1986, 5, 335–54.CrossRefGoogle Scholar
38.Sox, H. C., Margulies, I., & Sox, C. H.Psychologically mediated effects of diagnostic tests. Annals of Internal Medicine, 1981, 95, 680–85.Google Scholar
39.Swedlow, A., Johnson, G., Smithline, N., & Milstein, A.Increased costs and rates of use in the California workers' compensation system as a result of self-referral by physicians. New England Journal of Medicine, 1992, 327, 1502–06.Google Scholar
40.Thornbury, J. R.Clinical efficacy of diagnostic imaging: Love it or leave it. American Journal of Roentgenology, 1994, 162, 18.CrossRefGoogle ScholarPubMed
41.Torrance, G. W., Boyle, M. H., & Horwood, S. P.Application of multi-attribute utility theory to measure social preferences for health states. Operations Research, 1982, 30, 1043–71.CrossRefGoogle ScholarPubMed
42.Winn, H. R., Richardson, A. E., & Jane, J. A.The long term prognosis in untreated cerebral aneurysms, I: The incidence of late hemorrhage in cerebral aneurysm: A 10-year evaluation of 364 patients. Annals of Neurology, 1977, 1, 358–70.Google Scholar
43.Zulch, K. J.Brain tumors, their biology and pathology, 3rd ed.New York: Springer, 1986, 34.Google Scholar