Costs and diagnostic value of imaging in low back pain
Imaging (X-rays, CT and MRI) does not offer health benefits for patients with low back pain (LBP) and is also not recommended in clinical guidelines. It is unclear whether imaging leads to higher costs, use of care or absence at work. For this reason, the study systematically investigates whether imaging in patients with LBP leads to an increase in these outcomes.
PubMed, CINAHL, EMBASE, Cochrane Library and Web of Science were searched for randomized controlled trials (RCTs) and observational studies (OSs) until October 2017, comparing imaging with no imaging of targeted results, and two reviewers independently performed data extraction and risk. from bias assessment, using the GRADE method to determine the quality of the evidence.
Direct costs that increase for patients undergoing X-rays are supported by evidence of poor quality (1 RCT; n = 421). The fact that early MRI can lead to higher costs is supported by the evidence of low quality (3 OSs; n = 9535).
There is evidence of poor quality (1 RCT, 2 OSs; n = 3897) that performing MRI or imaging (MRI or CT) is associated with an increase in health care use (eg future injections, surgery, medication, etc.). Performing X-rays or MRI is associated with an increase in health care use with evidence of low quality (5 OSs; n = 15,493). Evidence of moderate quality (2 RCTs; n = 667) showed no significant differences between X-ray or MRI groups compared to non-imaging groups in the absence of work. Evidence of low quality (2 Oss; n = 7765) did show a significantly greater average absence of work in the MRI groups compared to the non-imaging groups.
Imaging in LBP can be associated with higher medical costs, increased use of healthcare and more absenteeism.