THE COST-EFFECTIVENESS OF MAGNETIC-RESONANCE-IMAGING FOR PATIENTS WITH EQUIVOCAL NEUROLOGICAL SYMPTOMS

Objective: To determine the incremental cost-effectiveness of magnetic resonance imaging (MRI) and computed tomography (CT) in young adults presenting with equivacal neurological signs and symptoms. Designs and -methods: A decision analysis of long-term-survival using accuracy dat a from a diagnostic technology assessment of MRI and CT in patients wi th:suspected multiple sclerosis, information from the medical literatu re, and clinical assumptions. Main,results: In the baseline analysis, at 30% likelihood of an underlying neurologic disease, MRI use has an incremental cost of $101,670 for each additional quality-adjusted life -year saved compared with $20,200 for CT use. As the probability of di sease increases, further MRI use becomes a cost-effective alternative costing $30,000 for each quality-adjusted life-year saved. If a negati ve MRI result provides reassurance, the incremental costs of immediate MRI use decreases and falls below $25,000 for each quality-adjusted l ife-year saved no matter the likelihood of disease. Conclusions: For m ost individuals,with neurological symptoms or signs, CT imaging is cos t-effective while MR imaging is not. The cost-effectiveness of MRI use , however, improves as the likelihood of an underlying neurological di sease increases. For selected patients who highly value diagnostic inf ormation, MRI is a reasonable and cost-effective use of medical resour ces when even the likelihood of disease is quite low (5%).