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

• Published in: International journal of technology assessment in health care 1997, Vol.13 (1), p.21-34
• Main Authors: Mushlin, Alvin I., Mooney, Cathleen, Holloway, Robert G., Detsky, Allan S., Mattson, David H., Phelps, Charles E.
• Format: Article
• Language: English
• Subjects: Adult; Biological and medical sciences; Central Nervous System Diseases - diagnosis; Central Nervous System Diseases - economics; Cost-Benefit Analysis; Decision Support Techniques; Female; General aspects; General Essays; Humans; Investigative techniques, diagnostic techniques (general aspects); Magnetic Resonance Imaging - economics; Medical sciences; Miscellaneous. Technology; Multiple Sclerosis - diagnosis; Multiple Sclerosis - economics; Planification. Prevention (methods). Intervention. Evaluation; Public health. Hygiene; Public health. Hygiene-occupational medicine; Quality-Adjusted Life Years; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Tomography, X-Ray Computed - economics
• ISSN: 0266-4623; 1471-6348
• DOI: 10.1017/S0266462300010205

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%).