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The Cost-Effectiveness of Magnetic Resonance Imaging for Patients with Equivocal Neurological Symptoms

Published online by Cambridge University Press:  10 March 2009

Alvin I. Mushlin ,
Cathleen Mooney ,
Robert G. Holloway ,
Allan S. Detsky ,
David H. Mattson  and
Charles E. Phelps
Alvin I. Mushlin
Affiliation:
University of Rochester
Cathleen Mooney
Affiliation:
University of Rochester
Robert G. Holloway
Affiliation:
University of Rochester
Allan S. Detsky
Affiliation:
University of Toronto
David H. Mattson
Affiliation:
University of Rochester
Charles E. Phelps
Affiliation:
University of Rochester
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Abstract

Objective: To determine the incremental cost-effectiveness of magnetic resonance imaging (MRI) and computed tomography (CT) in young adults presenting with equivocal neurological signs and symptoms. Designs and methods: A decision analysis of long-term survival using accuracy data from a diagnostic technology assessment of MRI and CT in patients with suspected multiple sclerosis, information from the medical literature, and clinical assumptions. Main results: In the baseline analysis, at 30% likelihood of an underlying neurologic disease, MRI use has an incremental cost of $101,670 for each additional quality-adjusted life-year saved compared with $20,290 for CT use. As the probability of disease increases, further MRI use becomes a cost-effective alternative costing $30,000 for each quality-adjusted life-year saved. If a negative MRI result provides reassurance, the incremental costs of immediate MRI use decreases and falls below $25,000 for each quality-adjusted life-year saved no matter the likelihood of disease. Conclusions: For most individuals with neurological symptoms or signs, CT imaging is cost-effective while MR imaging is not. The cost-effectiveness of MRI use, however, improves as the likelihood of an underlying neurological disease increases. For selected patients who highly value diagnostic information, MRI is a reasonable and cost-effective use of medical resources when even the likelihood of disease is quite low (5%).

Type
General Essays
Information
International Journal of Technology Assessment in Health Care , Volume 13 , Issue 1 , Winter 1997 , pp. 21 - 34
Copyright
Copyright © Cambridge University Press 1997

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