Early MRI referrals not cost-effective in patients with knee pain
A group of Dutch researchers found a general practitioner’s MRI referral for patients with traumatic knee symptoms led to increased healthcare costs without any improvement in outcomes, according to a study published online April 17 in Radiology.
In the past decade there’s been a shift toward earlier MRI in primary care for patients dealing with knee trauma, wrote corresponding author Kim van Oudenaarde, MD, with the Leiden University Medical Center in the Netherlands, and colleagues.
The thought is patients may avoid unnecessary referrals to secondary care or receive an earlier diagnosis and possibly recover quicker. But this new thinking lacks evidence, authors note.
The study included 356 participants, with an average age of 33. Cost-utility analysis and a prospective multicenter trial at a Dutch hospital were performed simultaneously.
Patients were either assigned to usual care (no routine referral to MR imaging, rather to an orthopedic surgeon in the case of persistent knee symptoms) or MRI within two weeks after injury.
Results showed, “MR imaging referral by the general practitioner was not cost-effective in patients with traumatic knee symptoms; in fact, MR imaging led to more healthcare costs, without an improvement in health outcomes,” wrote Oudenaarde et al.
There was little difference in quality of life years between the two study groups.
However, healthcare costs per patient were higher in the MRI group (1109 euros) than in the usual care group (837 euros). Authors attributed this to higher costs for MRI, and “because of more physiotherapy sessions and more arthroscopies, in addition to the study-initiated MR examinations.”
Oudenaarde and colleagues concluded that usual care should remain the guideline for patients with traumatic knee symptoms, although they acknowledge this may be a challenge in the current healthcare environment.
“Not to request an MR examination might be challenging in the current climate of defensive medicine, in which patients are demanding and healthcare providers have a limited amount of time,” wrote authors. “With the presented results, we hope to support both patients and healthcare providers in the primary evidence-based care of patients with traumatic knee symptoms.”
Matt joined Chicago’s TriMed team in 2018 covering all areas of health imaging after two years reporting on the hospital field. He holds a bachelor’s in English from UIC, and enjoys a good cup of coffee and an interesting documentary.