Natalia Gorelik1, Farah Tamizuddin2, Tatiane Cantarelli Rodrigues3, Luis Beltran4, Fardina Malik5, Soumya Reddy5, James Koo6, Naveen Subhas7, Soterios Gyftopoulos8. 1. Department of Radiology, McGill University Health Center, 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada. natalia.gorelik@mail.mcgill.ca. 2. New York University School of Medicine, 550 1st Avenue, New York, NY, 10016, USA. 3. Department of Radiology, Hospital do Coração (HCor) and Teleimagem, Rua Desembargador Eliseu Guilherme 53 - 7th floor, São Paulo, SP, 04004-030, Brazil. 4. Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA. 5. Department of Rheumatology, NYU School of Medicine, 333 East 38th Street, 4th Floor, New York, NY, 10016, USA. 6. Rusk Rehabilitation, NYU Langone Health, 333 East 38th Street, 5th Floor, New York, NY, 10016, USA. 7. Department of Radiology, Cleveland Clinic, 9500 Euclid Ave # A21, Cleveland, OH, 44195, USA. 8. Department of Radiology, NYU Langone Medical Center, 333 E 38th St, 6th Floor, New York, NY, 10016, USA.
Abstract
OBJECTIVE: The purpose of our study was to determine the cost-effectiveness of radiography and MRI-based imaging strategies for the initial diagnosis of sacroiliitis in a hypothetical population with suspected axial spondyloarthritis. MATERIALS AND METHODS: A decision analytic model from the health care system perspective for patients with inflammatory back pain suggestive of axial spondyloarthritis was used to evaluate the incremental cost-effectiveness of 3 imaging strategies for the sacroiliac joints over a 3-year horizon: radiography, MRI, and radiography followed by MRI. Comprehensive literature search and expert opinion provided input data on cost, probability, and utility estimates. The primary effectiveness outcome was quality-adjusted life-years (QALYs), with a willingness-to-pay threshold set to $100,000/QALY gained (2018 American dollars). RESULTS: Radiography was the least costly strategy ($46,220). Radiography followed by MRI was the most effective strategy over a 3-year course (2.64 QALYs). Radiography was the most cost-effective strategy. MRI-based and radiography followed by MRI-based strategies were not found to be cost-effective imaging options for this patient population. Radiography remained the most cost-effective strategy over all willingness-to-pay thresholds up to $100,000. CONCLUSION: Radiography is the most cost-effective imaging strategy for the initial diagnosis of sacroiliitis in patients with inflammatory back pain suspicious for axial spondyloarthritis.
OBJECTIVE: The purpose of our study was to determine the cost-effectiveness of radiography and MRI-based imaging strategies for the initial diagnosis of sacroiliitis in a hypothetical population with suspected axial spondyloarthritis. MATERIALS AND METHODS: A decision analytic model from the health care system perspective for patients with inflammatory back pain suggestive of axial spondyloarthritis was used to evaluate the incremental cost-effectiveness of 3 imaging strategies for the sacroiliac joints over a 3-year horizon: radiography, MRI, and radiography followed by MRI. Comprehensive literature search and expert opinion provided input data on cost, probability, and utility estimates. The primary effectiveness outcome was quality-adjusted life-years (QALYs), with a willingness-to-pay threshold set to $100,000/QALY gained (2018 American dollars). RESULTS: Radiography was the least costly strategy ($46,220). Radiography followed by MRI was the most effective strategy over a 3-year course (2.64 QALYs). Radiography was the most cost-effective strategy. MRI-based and radiography followed by MRI-based strategies were not found to be cost-effective imaging options for this patient population. Radiography remained the most cost-effective strategy over all willingness-to-pay thresholds up to $100,000. CONCLUSION: Radiography is the most cost-effective imaging strategy for the initial diagnosis of sacroiliitis in patients with inflammatory back pain suspicious for axial spondyloarthritis.
Entities:
Keywords:
Axial spondyloarthritis; Cost-effectiveness; Magnetic resonance imaging; Radiography; Sacroiliitis
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