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.

Methods

  • 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

Results

  • 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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