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

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Abstract

Objective

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).

Results

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.

Conclusion

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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Author information

Authors and Affiliations

  1. Department of Radiology, McGill University Health Center, 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada

    Natalia Gorelik

  2. New York University School of Medicine, 550 1st Avenue, New York, NY, 10016, USA

    Farah Tamizuddin

  3. Department of Radiology, Hospital do Coração (HCor) and Teleimagem, Rua Desembargador Eliseu Guilherme 53 - 7th floor, São Paulo, SP, 04004-030, Brazil

    Tatiane Cantarelli Rodrigues

  4. Department of Radiology, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA, 02115, USA

    Luis Beltran

  5. Department of Rheumatology, NYU School of Medicine, 333 East 38th Street, 4th Floor, New York, NY, 10016, USA

    Fardina Malik & Soumya Reddy

  6. Rusk Rehabilitation, NYU Langone Health, 333 East 38th Street, 5th Floor, New York, NY, 10016, USA

    James Koo

  7. Department of Radiology, Cleveland Clinic, 9500 Euclid Ave # A21, Cleveland, OH, 44195, USA

    Naveen Subhas

  8. Department of Radiology, NYU Langone Medical Center, 333 E 38th St, 6th Floor, New York, NY, 10016, USA

    Soterios Gyftopoulos

Authors
  1. Natalia Gorelik
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  7. James Koo
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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.

Ethical approval

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). https://doi.org/10.1007/s00256-020-03444-6

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  • DOI: https://doi.org/10.1007/s00256-020-03444-6

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