Radiographic Screening for Orbital Foreign Body Prior to MRI is Neither Cost Effective Nor Clinically Necessary as Recently Recommended

Abstract

To evaluate the cost effectiveness of clinical versus radiological screening for orbital foreign body prior to MRI. Costs of screening were developed using data available in medical literature, disability rating guides and practice survey. Base case estimates were derived based on published guidelines. A single state change model was constructed, social cost was the unit of analysis. Sensitivity analysis was performed over plausible ranges for each variable. Using base case estimates and a discount rate of zero, the cost of the current guideline is $328,580 per quality adjusted life year saved. The analysis identifies screening cost as a critical variable. Discount rates and effectiveness of foreign body removal also are important variables. Probability of injury and prevalence of foreign body may impact the analysis. Clinical screening prior to radiography would be expected to reduce the cost of screening by an order of magnitude, assuming base case ocular foreign body removal rates. Clinical screening prior to radiological screening would increase the cost effectiveness of foreign body screening by an order of magnitude. Simply asking the patient “Did a doctor get it all out?” accomplishes this goal Occupational history by itself is not sufficient to mandate radiological orbital screening. Current practice guidelines for foreign body screening should be altered.