Rapid magnetic resonance imaging for diagnosing cancer-related low back pain.
OBJECTIVE
This study compared the relative efficiency of lumbar x-ray and rapid magnetic resonance (MR) imaging for diagnosing cancer-related low back pain (LBP) in primary care patients.


METHODS
We developed a decision model with Markov state transitions to calculate the cost per case detected and cost per quality-adjusted life year (QALY) of rapid MR imaging. Model parameters were estimated from the medical literature. The costs of x-ray and rapid MR were calculated in an activity-based costing study.


METHODS
A hypothetical cohort of primary care patients with LBP referred for imaging to exclude cancer as the cause of their pain.


RESULTS
The rapid MR strategy was more expensive due to higher initial imaging costs and larger numbers of patients requiring conventional MR and biopsy. The overall sensitivity of the rapid MR strategy was higher than that of the x-ray strategy (62% vs 55%). However, because of low pre-imaging prevalence of cancer-related LBP, this generates <1 extra case per 1,000 patients imaged. Therefore, the incremental cost per case detected using rapid MR was high ($213,927). The rapid MR strategy resulted in a small increase in quality-adjusted survival (0.00043 QALYs). The estimated incremental cost per QALY for the rapid MR strategy was $296,176.


CONCLUSIONS
There is currently not enough evidence to support the routine use of rapid MR to detect cancer as a cause of LBP in primary care patients.
Hollingworth
William
W
Departments of Radiology, University of Washington, Seattle, Wash. 98103, USA. willh@u.washington.edu
Gray
Darryl T
DT
Martin
Brook I
BI
Sullivan
Sean D
SD
Deyo
Richard A
RA
Jarvik
Jeffrey G
JG
D001706:Biopsy / Q000191:economics; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis* / Q000191:economics / Q000209:etiology; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging; D008279:Magnetic Resonance Imaging / Q000191:economics* / Q000592:standards; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D011859:Radiography; D012680:Sensitivity and Specificity; D013125:Spinal Neoplasms / Q000150:complications* / Q000191:economics; D016019:Survival Analysis