From the Departments of Radiology (K.v.O., J.L.B., M.R.), Orthopaedics (R.G.H.H.N.), and Medical Decision Making (W.B.v.d.H.), Leiden University Medical Center, PO Box 9600, 2300 RC, Postal Zone C2-S, Leiden, the Netherlands; Departments of General Practice (N.M.S., P.J.E.B., B.W.K., P.A.J.L.) and Orthopaedics (S.M.A.B., J.A.N.V.), Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands; and Department of Radiology, Northwest Clinics, Alkmaar, the Netherlands (P.R.A.).
Radiology. 2018 Jul;288(1):170-176. doi: 10.1148/radiol.2018171383. Epub 2018 Apr 17.
Purpose To determine the cost-effectiveness of early referral by the general practitioner for magnetic resonance (MR) imaging compared with usual care alone in patients aged 18-45 years with traumatic knee symptoms. Materials and Methods Cost-utility analysis was performed parallel to a prospective multicenter randomized controlled trial in Dutch general practice. A total of 356 patients with traumatic knee symptoms were included from November 2012 to December 2015 (mean age, 33 years ± 8 [standard deviation]; 222 men [62%]). Patients were randomly assigned to usual care (n = 177; MR imaging was not performed, but patients were referred to an orthopedic surgeon when conservative treatment was unsatisfactory) or MR imaging (n = 179) within 2 weeks after injury. Main outcome measures were quality-adjusted life years (QALYs) and costs from a healthcare and societal perspective. Multiple imputation was used for missing data. The Student t test was used to assess differences in mean QALYs, costs, and net benefits. Results Mean QALYs were 0.888 in the MR imaging group and 0.899 in the usual care group (P = .255). Healthcare costs per patient were higher in the MR imaging group (€1109) than in the usual care group (€837) (P = .050), mainly due to higher costs for MR imaging, with no reduction in the number of referrals to an orthopedic surgeon in the MR imaging group. Conclusion MR imaging referral by the general practitioner was not cost-effective in patients with traumatic knee symptoms; in fact, MR imaging led to more healthcare costs, without an improvement in health outcomes.
在 18-45 岁有创伤性膝关节症状的患者中，比较全科医生的早期转诊进行磁共振成像（MR）与单纯常规护理相比的成本效益。
在荷兰普通实践中进行的前瞻性多中心随机对照试验的基础上进行成本效用分析。从 2012 年 11 月至 2015 年 12 月，共有 356 例创伤性膝关节症状患者纳入研究（平均年龄 33 岁±8 岁[标准差]；222 例男性[62%]）。患者在受伤后 2 周内随机分配至常规护理组（n=177；未行 MR 成像，但如果保守治疗不满意，将转诊给骨科医生）或 MR 成像组（n=179）。主要结局指标是从医疗保健和社会角度的质量调整生命年（QALY）和成本。采用多重插补法处理缺失数据。采用学生 t 检验评估平均 QALY、成本和净收益的差异。
MR 成像组的平均 QALY 为 0.888，常规护理组为 0.899（P=0.255）。MR 成像组每位患者的医疗保健成本（€1109）高于常规护理组（€837）（P=0.050），主要是由于 MR 成像成本较高，而 MR 成像组转诊至骨科医生的人数并未减少。
对于创伤性膝关节症状患者，全科医生的 MR 成像转诊并不具有成本效益；实际上，MR 成像导致了更多的医疗保健成本，而没有改善健康结果。
