Authors' objectives:

To establish whether the early use of sophisticated imaging techniques such as magnetic resonance imaging (MRI) or computed tomography (CT) influences the clinical management and outcome of patients with low back pain (LBP) and whether it is cost-effective.

Authors' results and conclusions: Participants in both groups reported an improvement in health status at 8 and 24 months with the early imaging group having statistically significantly better outcome. After adjustment for baseline score and other factors, the mean differences at 24 months were 3.62 points [95% confidence interval (CI) 5.92 to 1.32; p = 0.002] for the ALBP score and 0.057 (95% CI 0.013 to 0.101; p = 0.01) for the EQ-5D. The early imaging group also had significantly greater improvement in most subscales of the SF-36 at 8 months, but only for the Bodily Pain subscale at 24 months. Other than the proportion of participants receiving imaging (90% versus 30%), there were few differences between the groups in the management received throughout the 24-month follow-up. The total number of outpatient consultations in the two groups was similar although more people in the early imaging group had return outpatient appointments during the 8-month follow-up (p < 0.001). Clinicians diagnostic confidence, between trial entry and follow-up, increased significantly for both groups with a greater increase in the early imaging group (p = 0.01). The cost of imaging was the main determinant of the difference in total costs between the groups and it was estimated that early imaging could provide an additional 0.07 quality-adjusted life-years (QALYs), at an additional average cost of 61 GBP over the 24-month follow-up. Using non-imputed costs and QALYs but adjusted for baseline differences in EQ-5D score, the mean incremental cost per QALY of early imaging was 870 GBP. The results were sensitive to the costs of imaging and the confidence intervals surrounding estimates of average costs and QALYs.

Authors' recommendations: The early use of sophisticated imaging does not appear to affect management overall but does result in a slight improvement in clinical outcome at an estimated cost of 870 GBP per QALY. Imaging was associated with an increase in clinicians' diagnostic confidence, particularly for non-specialists.

Authors' methods: Randomised controlled trial

Project Status: Completed

URL for project: http://www.hta.ac.uk/897

Year Published: 2004

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England, United Kingdom

Organisation Name: NIHR Health Technology Assessment programme

Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK

Contact Name: journals.library@nihr.ac.uk

Contact Email: journals.library@nihr.ac.uk

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