Cost-effectiveness analysis of the diagnosis of meniscus tears.
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BACKGROUND: Diagnostic imaging represents the fastest growing segment of costs in the US health system. This study investigated the cost-effectiveness of alternative diagnostic approaches to meniscus tears of the knee, a highly prevalent disease that traditionally relies on MRI as part of the diagnostic strategy. PURPOSE: To identify the most efficient strategy for the diagnosis of meniscus tears. STUDY DESIGN: Economic and decision analysis; Level of evidence, 1. METHODS: A simple-decision model run as a cost-utility analysis was constructed to assess the value added by MRI in various combinations with patient history and physical examination (H&P). The model examined traumatic and degenerative tears in 2 distinct settings: primary care and orthopaedic sports medicine clinic. Strategies were compared using the incremental cost-effectiveness ratio (ICER). RESULTS: In both practice settings, H&P alone was widely preferred for degenerative meniscus tears. Performing MRI to confirm a positive H&P was preferred for traumatic tears in both practice settings, with a willingness to pay of less than US$50,000 per quality-adjusted life-year. Performing an MRI for all patients was not preferred in any reasonable clinical scenario. The prevalence of a meniscus tear in a clinician's patient population was influential. For traumatic tears, MRI to confirm a positive H&P was preferred when prevalence was less than 46.7%, with H&P preferred above that. For degenerative tears, H&P was preferred until the prevalence reaches 74.2%, and then MRI to confirm a negative was the preferred strategy. In both settings, MRI to confirm positive physical examination led to more than a 10-fold lower rate of unnecessary surgeries than did any other strategy, while MRI to confirm negative physical examination led to a 2.08 and 2.26 higher rate than H&P alone in primary care and orthopaedic clinics, respectively. CONCLUSION: For all practitioners, H&P is the preferred strategy for the suspected degenerative meniscus tear. An MRI to confirm a positive H&P is preferred for traumatic tears for all practitioners. Consideration should be given to implementing alternative diagnostic strategies as well as enhancing provider education in physical examination skills to improve the reliability of H&P as a diagnostic test. CLINICAL RELEVANCE: Alternative diagnostic strategies that do not include the use of MRI may result in decreased health care costs without harm to the patient and could possibly reduce unnecessary procedures.
Decision Support Techniques
False Negative Reactions
False Positive Reactions
Magnetic Resonance Imaging
Medical History Taking
Practice Patterns, Physicians'
Primary Health Care
Quality-Adjusted Life Years
Reproducibility of Results
Sensitivity and Specificity
Tibial Meniscus Injuries
Published Version (Please cite this version)10.1177/0363546514557937
Publication InfoBolognesi, Michael Paul; Cole, BJ; Garrett, WE; Hussey, K; Lassiter, T; Mather, Richard Charles III; & Orlando, Lori Ann (2015). Cost-effectiveness analysis of the diagnosis of meniscus tears. Am J Sports Med, 43(1). pp. 128-137. 10.1177/0363546514557937. Retrieved from http://hdl.handle.net/10161/10286.
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Professor of Orthopaedic Surgery
As chief of the adult reconstruction service, the majority of my research effort has been directed toward clinical outcomes, implant survivorship, functional recovery, the biology of hip and knee arthritis and cost effectiveness.
Assistant Professor of Orthopaedic Surgery
Richard C. “Chad” Mather III MD, MBA is an assistant professor and vice chairman of practice innovation in the Department of Orthopaedic Surgery at Duke University School of Medicine. He is also a faculty member at the Duke Clinical Research Institute. Dr. Mather is a health services researcher and decision scientist with a focus on economic analysis, health policy, health preference measurement and personalized decision-making. His current work focuses on buildi
Associate Professor of Medicine
Dr. Lori A. Orlando, MD MHS is an Associate Professor of Medicine and Director of the Precision Medicine Program in the Center for Applied Genomics and Precision Medicine at Duke University. She attended Tulane Medical Center for both medical school (1994-1998) and Internal Medicine residency (1998-2000). There she finished AOA and received a number of awards for teaching and clinical care from the medical school and the residency programs, including the Musser-Burch-Puschett award in 2000 fo
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