Cost-effectiveness of adding magnetic resonance imaging to rheumatoid arthritis management
JAMA Internal Medicine, 04/13/2011
Suter LG et al.
– Under plausible clinical conditions, adding MRI is not cost-effective compared with standard risk stratification in early-RA patients.
Used decision analysis model of standard risk stratification with or without MRI, followed by escalated standard treatment protocols based on treatment response
Estimated 1-year and lifetime quality-adjusted life-years, RA-related costs, and incremental cost-effectiveness ratios (with MRI vs without MRI) for RA patients with fewer than 12 months of disease and no baseline radiographic erosions
Inputs derived from published literature
assumed societal perspective with 3.0% discounting
One-year and lifetime incremental cost-effectiveness ratios for adding MRI to standard testing $204,103 and $167,783 per quality-adjusted life-year gained
In 1-way sensitivity analyses, model results insensitive to plausible ranges for every variable except MRI specificity, which published data suggest is below threshold for MRI cost-effectiveness
In probabilistic sensitivity analyses, most simulations produced lifetime incremental cost-effectiveness ratios in excess of $100,000 per quality-adjusted life-year gained, a commonly cited threshold
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