Department of Radiology, NYU Langone Medical Center/Hospital for Joint Diseases, New York, NY, USA.
Stony Brook University Medical Center, Stony Brook, NY, USA.
J Shoulder Elbow Surg. 2017 Dec;26(12):2067-2077. doi: 10.1016/j.jse.2017.07.012. Epub 2017 Sep 8.
The purpose of this study was to determine the value of magnetic resonance imaging (MRI) and ultrasound-based imaging strategies in the evaluation of a hypothetical population with a symptomatic full-thickness supraspinatus tendon (FTST) tear using formal cost-effectiveness analysis.
A decision analytic model from the health care system perspective for 60-year-old patients with symptoms secondary to a suspected FTST tear was used to evaluate the incremental cost-effectiveness of 3 imaging strategies during a 2-year time horizon: MRI, ultrasound, and ultrasound followed by MRI. Comprehensive literature search and expert opinion provided data on cost, probability, and quality of life estimates. The primary effectiveness outcome was quality-adjusted life-years (QALYs) through 2 years, with a willingness-to-pay threshold set to $100,000/QALY gained (2016 U.S. dollars). Costs and health benefits were discounted at 3%.
Ultrasound was the least costly strategy ($1385). MRI was the most effective (1.332 QALYs). Ultrasound was the most cost-effective strategy but was not dominant. The incremental cost-effectiveness ratio for MRI was $22,756/QALY gained, below the willingness-to-pay threshold. Two-way sensitivity analysis demonstrated that MRI was favored over the other imaging strategies over a wide range of reasonable costs. In probabilistic sensitivity analysis, MRI was the preferred imaging strategy in 78% of the simulations.
MRI and ultrasound represent cost-effective imaging options for evaluation of the patient thought to have a symptomatic FTST tear. The results indicate that MRI is the preferred strategy based on cost-effectiveness criteria, although the decision between MRI and ultrasound for an imaging center is likely to be dependent on additional factors, such as available resources and workflow.
本研究旨在通过正式的成本效益分析，确定磁共振成像（MRI）和基于超声的成像策略在评估疑似全层冈上肌腱（FTST）撕裂症状患者中的价值。
采用 60 岁疑似 FTST 撕裂症状患者的医疗保健系统视角下的决策分析模型，评估在 2 年时间内 3 种成像策略的增量成本效益：MRI、超声和超声后行 MRI。全面的文献检索和专家意见提供了成本、概率和生活质量估计数据。主要的有效性结果是 2 年内的质量调整生命年（QALY），支付意愿阈值设定为 10 万美元/QALY（2016 年美元）。成本和健康效益以 3%贴现。
超声是最具成本效益的策略（$1385）。MRI 是最有效的（1.332 QALY）。超声是最具成本效益的策略，但不具有优势。MRI 的增量成本效益比为每增加 1 个 QALY 需花费 22756 美元，低于支付意愿阈值。双向敏感性分析表明，MRI 在广泛的合理成本范围内优于其他成像策略。在概率敏感性分析中，MRI 在 78%的模拟中是首选的成像策略。
MRI 和超声是评估疑似症状性 FTST 撕裂患者的具有成本效益的成像选择。结果表明，根据成本效益标准，MRI 是首选策略，尽管对于成像中心而言，MRI 和超声之间的决策可能取决于其他因素，如可用资源和工作流程。
