Authors' objectives:

The objective of this report is to summarize the available evidence of the cost-effectiveness of computed tomography (CT) and magnetic resonance imaging (MRI) in investigating specific clinical conditions of the chest, cardiovascular, neurological, and urological systems.

Authors' results and conclusions: From the electronic database search, 18 of 315 studies were selected for inclusion, with an additional three studies (of 108) added after review of the grey literature. These 21 studies covered eight clinical conditions: PVD, renal artery stenosis, lung cancer screening, PE, carotid artery disease, cerebral aneurysms, head injuries and stroke. No economic studies addressed coronary artery disease, headaches, seizures, AVMs, or urinary tract calculi screening. The studies included in this review suggest that CT or MRI are effective for some conditions (especially PVD and stroke), but they are not necessarily more effective or cost-effective than traditional alternatives (for PVD). For other conditions, the evidence of cost-effectiveness appears positive but limited (renal artery stenosis and mild head injuries). The evidence for effectiveness or cost-effectiveness of CT or MRI for lung cancer screening, PE, carotid artery disease, and cerebral aneurysms is equivocal or conflicting. This study has several limitations, including the quality of available literature, the absence of literature addressing the most current technology, and issues inherent to cost-effectiveness analysis, such as ignoring competing priorities and assuming that resources are available for deployment or redeployment.

Authors' recommendations: The indications for CT and MRI, and their performance compared with earlier generations of the same technologies, are advancing faster than the available literature. As a result, this report may be dated in some areas. Years after CT and MRI techniques have been first advocated or come into use, it remains difficult to find high quality studies that address their use. For this report, no studies were found that addressed the cost-effectiveness of CT and MRI for coronary artery disease, headaches, seizures, AVMs, or urinary tract calculi screening. The studies included in this report suggest that CT and MRI are cost-effective in the investigation of some controversial clinical conditions (especially PVD and stroke), but not necessarily more effective or cost-effective than traditional alternatives (for PVD). For other clinical conditions, there is evidence of cost-effectiveness, but it is limited (renal artery stenosis, mild head injuries). The evidence for cost-effectiveness of CT and MRI for lung cancer screening, PE, carotid artery disease, and cerebral aneurysms is equivocal or conflicting. Regardless of the actual or perceived utility of CT and MRI, there remains a need to document their effectiveness and cost-effectiveness in specific areas of clinical practice.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.cadth.ca/

Year Published: 2006

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Canada

Organisation Name: Canadian Agency for Drugs and Technologies in Health

Contact Address: 600-865 Carling Avenue, Ottawa, ON K1S 5S8 Canada. Tel: +1 613 226 2553; Fax: +1 613 226 5392;

Contact Name: requests@cadth.ca

Contact Email: requests@cadth.ca

Copyright: Canadian Agency for Drugs and Technologies in Health (CADTH)