Comparison between radiography and magnetic resonance imaging for the detection of sacroiliitis in the initial diagnosis of axial spondyloarthritis: a cost-effectiveness study



The purpose of our study was to determine the cost-effectiveness of radiography and MRI-based imaging strategies for the initial diagnosis of sacroiliitis in a hypothetical population with suspected axial spondyloarthritis.

Materials and methods

A decision analytic model from the health care system perspective for patients with inflammatory back pain suggestive of axial spondyloarthritis was used to evaluate the incremental cost-effectiveness of 3 imaging strategies for the sacroiliac joints over a 3-year horizon: radiography, MRI, and radiography followed by MRI. Comprehensive literature search and expert opinion provided input data on cost, probability, and utility estimates. The primary effectiveness outcome was quality-adjusted life-years (QALYs), with a willingness-to-pay threshold set to $100,000/QALY gained (2018 American dollars).


Radiography was the least costly strategy ($46,220). Radiography followed by MRI was the most effective strategy over a 3-year course (2.64 QALYs). Radiography was the most cost-effective strategy. MRI-based and radiography followed by MRI-based strategies were not found to be cost-effective imaging options for this patient population. Radiography remained the most cost-effective strategy over all willingness-to-pay thresholds up to $100,000.


Radiography is the most cost-effective imaging strategy for the initial diagnosis of sacroiliitis in patients with inflammatory back pain suspicious for axial spondyloarthritis.

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Corresponding author

Correspondence to Natalia Gorelik.

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Conflict of interest

Author #5 declares a financial relationship with the Pfizer Psoriatic Arthritis Advisory Panel, outside the submitted work.

Author #6 declares a financial relationship with Abbvie (clinical trials, consulting fees), Amgen (clinical trials, consulting fees), UCB (consulting fees), Pfizer (clinical trials, consulting fees), Novartis (clinical trials, consulting fees), and Celgene (clinical trials), outside the submitted work.

The other authors declare that they have no relevant conflicts of interest.

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This study did not require Institutional Review Board review as it does not constitute human subjects research.

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Gorelik, N., Tamizuddin, F., Rodrigues, T.C. et al. Comparison between radiography and magnetic resonance imaging for the detection of sacroiliitis in the initial diagnosis of axial spondyloarthritis: a cost-effectiveness study. Skeletal Radiol 49, 1581–1588 (2020).

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  • Cost-effectiveness
  • Sacroiliitis
  • Axial spondyloarthritis
  • Radiography
  • Magnetic resonance imaging