Diagnostic Imaging Strategies for Occult Hip Fractures: A Decision and Cost–Effectiveness Analysis

Abstract

MRI is a cost-effective strategy for the diagnosis of an occult hip fracture. For facilities without MRI capability, the most cost-effective strategy depends on the cost of the interfacility transfer.

Using Cost-Effectiveness Analysis to Measure Value in Musculoskeletal Imaging

“…For example, Yun et al demonstrated that the selective MRI strategy (performing CT and, if negative, performing MRI) in patients with occult hip fractures was dominated by the universal MRI strategy. 19 Incremental costeffectiveness ratios (ICERs) are only necessary and meaningful if a strategy is both more costly and more effective, or both less costly and less effective. By using the appropriate cost perspective and the additional health benefit in QALYs, the costs per QALY can be calculated and compared with a predefined threshold value.…”

“…For example, in a recent study, Yun et al concluded that MRI provides an additional 0.05 QALY at an incremental cost of $1,227 with an ICER of $25,438/QALY in patients with occult hip fractures. 19…”

“…If these data are not available, observational studies can be used to obtain relevant parameters. 19 A limited follow-up period is usually available in clinical trials. To estimate future costs and effects, a decision model can be used to extrapolate beyond the trial results.…”

“…[20][21][22] Although these models are particularly relevant to MSK diseases because these usually involve risk over time, until now their use in the evaluation in MSK imaging was limited. 19 To address heterogeneity in a population, a virtual cohort of subjects representative of the population can be constructed. Each of these subgroups is modeled by letting them start out in the appropriate health state.…”

“…All subjects are flagged so their characteristics and individual disease histories can be tracked. 8,19 Special variables, so-called tracker variables, are used to model an individual's age, gender, risk factors, symptoms, underlying disease progression, disease history, medical procedures, and anything else that may be important to the prognosis. Individual subjects are tracked until some stopping criterion, usually the patient's death.…”