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Magnetic resonance imaging for investigation of the knee joint: A clinical and economic evaluation

  • Stirling Bryan (a1), Hilary P. Bungay (a2), Gwyn Weatherburn (a3) and Stuart Field (a2)

Abstract

Objectives: The aim of the study reported here was to investigate whether the use of magnetic resonance imaging (MRI) impacts on the clinical management of patients presenting with chronic knee problems, reduces costs, and improves patient outcome.

Methods: A single-center randomized controlled trial was conducted. Patients attending with knee problems in whom surgery was being considered were randomized either to investigation using an MRI scan or to investigation using arthroscopy. The study investigated benefits in terms of avoidance of surgery and patient health-related quality of life (using SF-36 and EQ-5D). Costs were assessed from the perspectives of the National Health Service and patients. All analyses were by intention to treat.

Results: The trial recruited 118 patients. No statistically significant differences were found between groups in terms of health outcome. However, the use of MRI was associated with a positive diagnostic/therapeutic impact: a significantly smaller proportion of patients in the MRI group underwent surgery (MRI=0.41, No-MRI=0.71; p value=.001). There was a similar mean overall cost for both groups.

Conclusions: The use of MRI in patients with chronic knee problems, in whom surgery was being considered, did not increase costs overall, was not associated with worse outcomes, and avoided surgery in a significant proportion of patients.

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Altman DG. 1991 Practical statistics for medical research. London: Chapman and Hall
Amemiya T. 1973 Regression analysis when the dependent variable is truncated. Normal Econometrica. 41: 9971016.
Barnet MJ. 1993 MR diagnosis of internal derangements of the knee: effect of field strength on efficacy. AJR Am J Roentgenol. 161 115118.
Birch N Powles D Dorrell H Brooks P 1994 The investigation and treatment of disorders of the knee: Indications and a cost-comparison of arthroscopy and magnetic resonance imaging. Health Trends. 26: 5052.
Brazier JE Harper R Jones NMB, et al. 1992 Validating the SF-36 health survey questionnaire: New outcome measure for primary care. BMJ. 305: 160164.
Briggs A Gray A 1998 The distribution of health care costs and their statistical analysis for economic evaluation. J Health Serv Res Policy. 3: 233245.
Brooks R 1996 EuroQol: The current state of play. Health Policy 37: 5372.
Brooks RG 1991 How should health status and quality of life be measured? IHE information. 3: 45.
Chissell HR Allum RL Keightley A. 1994 MRI of the knee: Its cost-effective use in a district general hospital. Ann R Coll Surg Engl. 76: 2629.
Crues JV Mink J Levy TL, Lotysch M, Stoller DW. 1987 Meniscal tears of the knee: Accuracy of MR imaging. Radiology. 164: 445448.
Desgagne A Castilloux AM Angers JF LeLorier J 1998 The use of the bootstrap statistical method for the pharmacoeconomic cost analysis of skewed data. Pharmacoeconomics. 13: 487497.
Dixon AK 1996 Magnetic resonance imaging of meniscal tears of the knee. Editorial. J Bone Joint Surg Br. 78: 174175.
Fineberg HV Bauman R Sosman M 1977 Computerized cranial tomography. JAMA. 238: 224227.
Fischer SP Fox JM Del Pizzo W, et al. 1991 Accuracy of diagnoses from magnetic resonance imaging of the knee. A multi-centre analysis of one thousand and fourteen patients. J Bone Joint Surg Am. 73: 210.
Garratt A Ruta DA Abdalla MI Buckingham JK Russell IT. 1993 The SF 36 health survey questionnaire: An outcome measure suitable for routine use within the NHS? BMJ. 306: 14401444.
Glashow JL Katz R Schneider M Scott WN 1989 Double-blind assessment of the value of magnetic resonance imaging in the diagnosis of anterior cruciate and meniscal lesions. J Bone Joint Surg Am. 71: 113119.
Hailey D 1997 An assessment of the status of magnetic resonance imaging in health care. J Qual Clin Pract. 17: 221230.
Hollingworth W Mackenzie R Todd CJ Dixon AK 1995 Measuring changes in quality of life following magnetic resonance imaging of the knee: SF-36, EuroQol or Rosser index? Qual Life Res. 4: 325334.
Hurst NP Jobanputra P Hunter M, et al. 1994 Validity of EuroQol – A generic health status instrument – In patients with rheumatoid arthritis. Br J Rheumatol. 33: 655662.
James P Buirski G. 1990 MR imaging of the knee: A prospective trial using a low strength magnet. Australas Radiol. 34: 5963.
Jenkinson C Coulter A Wright L 1993 Short Form 36 (SF 36) health survey questionnaire: Normative data for adults of working age. BMJ. 306: 14371440.
Lee JK Yao L Phelps CT 1988 Anterior cruciate ligament tears; MR imaging compared with arthroscopy and clinical tests. Radiology. 166: 861864.
Lundberg M Odensten M Thuomas Messner K 1996 The diagnostic validity of magnetic resonance imaging in acute knee injuries with hemarthrosis. A single-blinded evaluation in 69 patients using high-field MRI before arthroscopy. Int J Sports Med. 17: 21922.
MacKenzie R Dixon AK Keene GS, et al. 1996 Magnetic resonance imaging of the knee: Assessment of effectiveness. Clin Radiol. 51: 245250.
Mackenzie R Palmer CR Lomas DJ Dixon AK 1996 Magnetic resonance imaging of the knee: Diagnostic performance statistics. Clin Radiol. 51: 251257.
Mink JH Levy T Crues JV 1988 Tears of the anterior cruciate ligament and menisci of the knee: MR imaging evaluation. Radiology. 167: 769774.
Polly DW Callaghan JJ Sikes RA, et al. 1988 The accuracy of selective magnetic resonance imaging compared with the findings of arthroscopy of the knee. J Bone Joint Surg Am. 70: 192198.
Rubin DA Kettering JM Towers JD Britton CA 1998 MR imaging of knees having isolated and combined ligament injuries. AJR Am J Roentgenol. 170: 12071213.
Ruwe PA Wright J Randall RL, et al. 1992 Can MR imaging effectively replace diagnostic arthroscopy? Radiology. 183: 335339.
Ware JE Sherbourne DC 1992 The MOS 36-item short-form health survey (SF-36). Med Care. 30: 47383.
Warwick DJ Cavanagh P Bell M Marsh CH 1993 Influence of magnetic resonance imaging on a knee arthroscopy waiting list. Injury. 24: 380382.
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International Journal of Technology Assessment in Health Care
  • ISSN: 0266-4623
  • EISSN: 1471-6348
  • URL: /core/journals/international-journal-of-technology-assessment-in-health-care
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