Cost-effectiveness analysis of the diagnosis of meniscus tears.

dc.contributor.author

Mather, Richard C

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Garrett, William E

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Cole, Brian J

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Hussey, Kristen

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Bolognesi, Michael P

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Lassiter, Tally

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Orlando, Lori A

dc.coverage.spatial

United States

dc.date.accessioned

2015-07-14T23:05:59Z

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2015-01

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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.

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http://www.ncbi.nlm.nih.gov/pubmed/25451791

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0363546514557937

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1552-3365

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https://hdl.handle.net/10161/10286

dc.language

eng

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SAGE Publications

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Am J Sports Med

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10.1177/0363546514557937

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MRI

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cost

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cost-effectiveness analysis

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decision analysis

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economic analysis

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health policy

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meniscus tears

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physical examination

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Adult

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Aged

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Arthroscopy

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Cost-Benefit Analysis

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Decision Support Techniques

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False Negative Reactions

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False Positive Reactions

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Female

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Humans

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Magnetic Resonance Imaging

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Male

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Medical History Taking

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Middle Aged

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Orthopedics

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Physical Examination

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Practice Patterns, Physicians'

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Prevalence

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Primary Health Care

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Quality-Adjusted Life Years

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Reproducibility of Results

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Rupture

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Rupture, Spontaneous

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Sensitivity and Specificity

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Tibial Meniscus Injuries

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United States

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Unnecessary Procedures

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Young Adult

dc.title

Cost-effectiveness analysis of the diagnosis of meniscus tears.

dc.type

Journal article

duke.contributor.orcid

Bolognesi, Michael P|0000-0003-1414-6863

duke.contributor.orcid

Lassiter, Tally|0000-0003-2904-6881

duke.contributor.orcid

Orlando, Lori A|0000-0003-2534-7855

pubs.author-url

http://www.ncbi.nlm.nih.gov/pubmed/25451791

pubs.begin-page

128

pubs.end-page

137

pubs.issue

1

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Clinical Science Departments

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Duke

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Duke Clinical Research Institute

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Institutes and Centers

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Medicine

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Medicine, General Internal Medicine

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Orthopaedics

pubs.organisational-group

School of Medicine

pubs.publication-status

Published

pubs.volume

43

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