The cost-effectiveness of Magnetic Resonance Imaging (MRI) for investigation of the knee joint

• Register: ISRCTN
• Last refreshed on: 12 February 2013
• Main ID: ISRCTN17898966
• Date of registration: 25/04/2003
• Primary sponsor: Department of Health (UK)
• Public title: The cost-effectiveness of Magnetic Resonance Imaging (MRI) for investigation of the knee joint N/A
• Date of first enrolment: Jan 1 1996
• Target sample size: 118
• Recruitment status: Completed/Not recruiting
• URL: http://isrctn.org/ISRCTN17898966
• Study type: Interventional
• Study design: Single centre, randomised controlled trial

Countries of recruitment

United Kingdom

Contacts

• Name: Stirling Bryan

Key inclusion & exclusion criteria

Inclusion criteria: Patients attending with knee problems in whom surgery was being considered were recruited from routine orthopaedic clinics.
Exclusion criteria: No exclusion criteria

Age minimum:
Age maximum:
Gender:

Health Condition(s) or Problem(s) studied

Musculoskeletal injury

Intervention(s)

The research was based on a single-centre randomised controlled trial conducted at Kent and Canterbury Hospital.

Patients were randomised to:
1. Investigation using an MRI scan (MRI trial arm), or
2. Investigation using arthroscopy (no-MRI trial arm)

Investigation of diagnostic accuracy:
For the investigation of diagnostic accuracy of initial clinical investigation, the sample comprised 114 patients recruited in a separate study conducted at St Thomas? Hospital. The sample was drawn from patients presenting at the Accident and emergency Department with an acute knee injury. All study patients received an MRI scan, but initial diagnosis was made without access to the scan or the radiologist?s report. After 12 months, all clinical notes and MRI scans of study patients were reviewed and a final ?reference standard? diagnosis for each patient was reached. Comparison was made between the diagnosis recorded by each clinician (i.e. orthopaedic trainee, knee specialist and consultant radiologist) and the reference diagnosis.

Investigation of the generalisability of results:
For this substudy, the MRI images from 80 patients (recruited at St Thomas? Hospital) were interpreted independently by seven consultant radiologists at DGHs and the St Thomas? Hospital MRI radiologist. For each area of the knee, the level of agreement (measured using weighted kappa) between the responses of the eight radiologists and the reference standard diagnosis was assessed.

Investigation of preferences:
The investigation of potential patient preferences for the diagnostic/therapeutic impact of MRI was explored using a discrete choice conjoint measurement research design. Choices involved selecting between two alternative scenarios described using four attributes, and data were collected from 585 undergraduate sports science students and analysed using a random-effects probit model.

Primary Outcome(s)

The study investigated the benefits of knee MRI at two levels:
1. Diagnostic/therapeutic impact (i.e. avoidance of surgery)
2. Patient outcome (using the 36-item Short Form questionnaire [SF-36] and the EuroQoL quality-of-life measurement instruments [EQ-5D]); quality of life was assessed at baseline and at 6 and 12 months

Costs were assessed from the perspectives of the NHS and patients. All analyses were by intention to treat.

Secondary Outcome(s)

No secondary outcome measures

Secondary ID(s)

HTA 93/26/16

Source(s) of Monetary Support

NIHR Health Technology Assessment Programme - HTA (UK)

Secondary Sponsor(s)

N/A