Tiago Rua1, Sam Gidwani2, Bharti Malhotra3, Sanjay Vijayanathan3, Laura Hunter4, Janet Peacock5, Joanna Turville3, Reza Razavi6, Vicky Goh7, Paul McCrone8, James Shearer8. 1. 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. Electronic address: tiago.rua@kcl.ac.uk. 2. Department of Orthopaedics, Guy's and St Thomas' NHS Foundation Trust, London, England, UK. 3. Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London, England, UK. 4. Emergency Department, Guy's and St Thomas' NHS Foundation Trust, London, England, UK. 5. School of Population Health and Environmental Sciences, King's College London, London, England, UK. 6. Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London, England, UK; Vice President & Vice-Principal (Research), King's College London, London, England, UK. 7. Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London, England, UK; Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, London, England, UK. 8. King's Health Economics, King's College London, London, England, UK.
Abstract
OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.
RCT Entities:
OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.
Authors: Benjamin J F Dean; Christopher Little; Nicholas D Riley; Edward Sellon; Warren Sheehan; Jenna Burford; Phil Hormbrey; Matthew L Costa Journal: Bone Jt Open Date: 2021-06