King's Health Economics, King's College London, London, England, UK; Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London, England, UK.
Department of Orthopaedics, Guy's and St Thomas' NHS Foundation Trust, London, England, UK.
Value Health. 2020 Nov;23(11):1444-1452. doi: 10.1016/j.jval.2020.05.020. Epub 2020 Sep 29.
Given the limited diagnostic accuracy of radiographs on presentation to the emergency department (ED), the management of suspected scaphoid fractures remains clinically challenging and poses an unknown economic burden to healthcare systems. We aimed to evaluate the cost-effectiveness of immediate magnetic resonance imaging (MRI) in the management of patients presenting with suspected scaphoid fracture to an ED in England.
A pragmatic, randomized, single-center trial compared the use of immediate MRI in the ED against standard care with radiographs only. Participants' use of healthcare services and costs were estimated from primary care and secondary care databases and questionnaires at baseline, 1, 3, and 6 months postrecruitment. Costs were compared using generalized linear models and combined with quality-adjusted life years (QALYs, based on the EQ-5D-5L) to estimate cost-effectiveness at 6 months postrecruitment. Cost-effectiveness acceptability curves and bootstrapping techniques were used to estimate the probability of cost-effectiveness at different willingness-to-pay (WTP) thresholds. Four deterministic sensitivity scenarios were considered around key parameters.
The MRI intervention dominated standard care in the base case and all 4 deterministic sensitivity scenarios, costing less and achieving more QALY gains, with a probability of 100% of being cost-effective at 6 months using the conventional United Kingdom WTP thresholds of £20 000 to £30 000 per QALY.
The use of immediate MRI is a cost-effective intervention in the management of suspected scaphoid fractures in a Central Hospital in London. Routine clinical practice at our institution has been changed to include the intervention.
鉴于就诊于急诊科时 X 光片的诊断准确性有限，疑似舟状骨骨折的管理仍然具有临床挑战性，并对医疗保健系统造成未知的经济负担。我们旨在评估在英格兰急诊科就诊疑似舟状骨骨折患者中立即行磁共振成像（MRI）检查的成本效益。
一项实用的、随机的、单中心试验比较了在急诊科立即行 MRI 检查与仅行 X 光检查的标准护理方法。通过初级保健和二级保健数据库以及招募后 1、3 和 6 个月的问卷，估计参与者的医疗服务使用情况和费用。使用广义线性模型比较成本，并结合质量调整生命年（基于 EQ-5D-5L 的 QALY），以估计招募后 6 个月的成本效益。使用成本效益接受曲线和自举技术来估计在不同支付意愿（WTP）阈值下的成本效益概率。考虑了 4 个围绕关键参数的确定性敏感性情景。
MRI 干预在基础情况和所有 4 个确定性敏感性情景中均优于标准护理，成本更低，QALY 获益更多，使用英国传统的 20000 至 30000 英镑/QALY 的 WTP 阈值，6 个月时具有 100%的成本效益概率。
在伦敦中心医院中，立即行 MRI 检查是疑似舟状骨骨折管理的一种具有成本效益的干预措施。我们机构的常规临床实践已经改变，包括了该干预措施。
