MRI Offers No Added Value In RA Risk Stratification
MRI is no more cost-effective than standard risk stratification techniques in determining whether newly diagnosed rheumatoid arthritis (RA) patients will benefit from aggressive treatment is no more cost-effective than standard risk stratification techniques, according to researchers at the Yale School of Medicine in New Haven, Conn. To conduct their cost-effectiveness analysis, Lisa G. Suter, MD and her colleagues first developed a "hypothetical population" of patients 45 and older who had had RA for 12 months or less with no evidence of bone erosion. A model to gauge MRI cost-effectiveness, which took into account treatment response, type of treatment received, adverse event risks, and more, was then created. Based on the analysis, the one-year incremental cost effectiveness ratio (ICER) for adding MRI to standard risk stratification was $204,103 for each quality-adjusted life-year (QALY) gained. The lifetime ICER totaled $167,783 per QALY. Suter and her colleagues note that despite the controversy surrounding the acceptable cost per QALY of a given treatment, most estimates for the U.S. range from $50,000 to triple the per-person gross domestic product, or roughly $144,000. The researchers also note that while some individuals with RA will benefit from early, aggressive treatment, patients may also improve on their own, and aggressive treatment is costly and risky. At present, they add, physicians stratify RA patients by risk via conventional radiography and clinical and laboratory testing. Given that MRI will identify bone erosion and its precursors sooner than radiography, some researchers have proposed using it as a risk stratification tool. "Our data suggest MRI is unlikely to be a cost-effective addition to standard prognostic assessments, despite using highly conservative assumptions (that is, those based in favor of MRI), including assumptions regarding the quality-of-life effect of RA or complications of treatments," the researchers say. In order to be cost-effective, they assert, MRI would need to be significantly more sensitive, and at least as specific, as standard testing. "Given our findings in combination with the fact that non-radiologist MRI facility ownership is increasing, our data support a prudent approach to technology adoption in RA risk stratification,” Suter and her team conclude. “Data clearly defining the clinical benefit of MRI in early-RA treatment are urgently needed."