Rapid magnetic resonance imaging for diagnosing cancer-related low back pain: A cost-effectiveness analysis

William Hollingworth, Darryl T. Gray, Brook I. Martin, Sean D. Sullivan, Richard A. Deyo, Jeffrey G. Jarvik

Research output: Contribution to journalReview articlepeer-review

24 Scopus citations


OBJECTIVES: This study compared the relative efficiency of lumbar x-ray and rapid magnetic resonance (MR) imaging for diagnosing cancer-related low back pain (LBP) in primary care patients. DESIGN: We developed a decision model with Markov state transitions to calculate the cost per case detected and cost per quality-adjusted life year (QALY) of rapid MR imaging. Model parameters were estimated from the medical literature. The costs of x-ray and rapid MR were calculated in an activity-based costing study. SETTING AND PATIENTS: A hypothetical cohort of primary care patients with LBP referred for imaging to exclude cancer as the cause of their pain. MAIN RESULTS: The rapid MR strategy was more expensive due to higher initial imaging costs and larger numbers of patients requiring conventional MR and biopsy. The overall sensitivity of the rapid MR strategy was higher than that of the x-ray strategy (62% vs 55%). However, because of low preimaging prevalence of cancer-related LBP, this generates <1 extra case per 1,000 patients imaged. Therefore, the incremental cost per case detected using rapid MR was high ($213,927). The rapid MR strategy resulted in a small increase in quality-adjusted survival (0.00043 QALYs). The estimated incremental cost per QALY for the rapid MR strategy was $296,176. CONCLUSIONS: There is currently not enough evidence to support the routine use of rapid MR to detect cancer as a cause of LBP in primary care patients.

Original languageEnglish (US)
Pages (from-to)303-312
Number of pages10
JournalJournal of general internal medicine
Issue number4
StatePublished - Apr 1 2003
Externally publishedYes


  • Cost-effectiveness analysis
  • Decision analysis
  • Low back pain
  • Magnetic resonance imaging
  • Radiography

ASJC Scopus subject areas

  • Internal Medicine


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