Cost-Effectiveness of Immediate Magnetic Resonance Imaging in the Management of Patients With Suspected Scaphoid Fracture: Results From a Randomized Clinical Trial

Tiago Rua*, Sam Gidwani, Bharti Malhotra, Sanjay Vijayanathan, Laura Hunter, Janet Peacock, Joanna Turville, Reza Razavi, Vicky Goh, Paul McCrone, James Shearer

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

10 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)1444-1452
Number of pages9
JournalValue in Health
Volume23
Issue number11
DOIs
Publication statusPublished - Nov 2020

Keywords

  • cost-utility analysis
  • health economics
  • magnetic resonance imaging
  • pragmatic clinical trial
  • suspected scaphoid fracture

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