Addendum to: Options and strategies to drive appropriate use of MRI in Austria II

Agnes Kisser & Christoph Naimer
Duration:  April 2015 - October 2015
Publication: LBI-HTA Project report No. 80b: https://eprints.aihta.at/1090/

Language: Deutsch

Background:

With more than 100 MRI investigations per year and 1000 persons, Austria is leading in MRI utilisation in comparison to other OECD countries (1). In 2009 a capping of reimbursement expenses for MRI investigations in the outpatient sector was introduced. Since then critics state that the expense limit leads to long waiting times and underprovision of patients. On the other hand, the appropriateness of medical imaging in screening in diagnosis is increasingly under debate.

For imaging methods, high level evidence from RCT is usually not available. Thus, other methods combining available evidence with expert consensus in a transparent and systematic way are used to define appropriateness criteria (2, 3). These criteria will then need to be implemented through guidelines, decision support tools, dissemination and monitoring.

In a systematic database search for disinvestment recommendations and appropriateness criteria we have identified over 200 recommendations against the use of MRI for defined indications (1). We further recommended educational interventions, the revision of the Austrian referral guideline, the development of decision support tools and an improved information exchange (1).

Aim of the project:

The aim of the project is to research and compile additional information on the recommendations identified in (1) for defined indications.

Methods:

For selected body regions or indications (e.g. spine, shoulder, knee, head) the following information will be researched by a limited literature search and compiled for use by the working group HVB/WKÖ:

• Recommendations from international evidence-based guidelines (D or E)
• Evidence tables and rating reports
• Diagnostic Algorithms from Western Australia Diagnostic Imaging Pathways or similar
• Pre-test-probabilities of the selected indications
• Changes in patient management (% of following actions)
• Product overview

Timeline/ Milestones:

Mar 2015 – Oct 2015

März 2015-April 2015: Scoping meetings, preparation of the project protocol

References:

(1) Kisser A, Mayer J, Wild C. Opportunities and strategies to drive appropriate use of MRI in Austria. LBI-HTA Projektbericht Nr.: 80; 2014. Wien: Ludwig Boltzmann Institut für Health Technology Assessment

(2) Mayer J, Nachtnebel A. Identifikation ineffektiver Interventionen und Technologien. Modelle und deren Umsetzung. HTA-Projektbericht Nr.: 68; 2013. Wien: Ludwig Boltzmann Institut für Health Technology Assessment .

(3) Fitch K, et al. The RAND/UCLA appropriateness method user’s manual