Health-Related Quality of Life and Cost-Effectiveness Analysis in Radiology 1 Ania Zofia Kielar, MD, FRCPC, Robert H. El-Maraghi, MD, FRCPC, Ruth C. Carlos, MD The number of radiological studies performed annually, including ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI), has been increas- ing dramatically. This trend is influenced by several fac- tors, including an aging population with multiple comor- bidities and a higher number of overall studies obtained per patient and/or per time period (1). More than ever before, radiology is playing an integral role during both initial investigations and follow-up of patients with acute and chronic illnesses. For example, Beinfeld and Gazelle (2) determined that medical technology has accounted for 19% of the growth in hospital costs between 1998 and 2000 and that imaging costs at one major tertiary care center increased by 50% between 1996 and 2002. In this challenging practice environment, evidence- based medicine has been recognized as an essential tool for deciding on appropriate diagnostic, medical, and inter- ventional care for patients. Additionally, greater emphasis is being placed on cost-effectiveness analysis (CEA) and health-related quality of life (HRQOL) outcomes to guide utilization of high-tech, often high-cost, diagnostic and therapeutic radiological resources. Equally important (per- haps more so in certain situations), these often less tangi- ble values are increasingly being measured in addition to the physical outcomes. Much of the early development of HRQOL assessments focused specifically on patients with cancer (3–5) and those with chronic renal failure on he- modialysis (6). In these two groups of patients, newly introduced therapies were sometimes associated with modest improvements in survival but simultaneously with potentially significant morbidity. In the field of radiology, CEA and HRQOL measurements can be applied to most patient-related scenarios, including screening tests that use imaging, as well as diagnostic radiology studies and inter- ventional procedures. UNDERSTANDING HEALTH-RELATED QUALITY OF LIFE Quality of life (QOL) is a concept with many mean- ings and encompassing many themes. HRQOL may be defined as the value assigned to the duration of life, as it is modified by impairments of functional health states, caused by disease, injury, attempted treatment, or a policy (7). It can be used to evaluate radiology-related studies in the same way in which it is used in other medical and surgical fields. There are several core domains of HRQOL that are typically included in a global assess- ment. These include health perceptions, social functions (such as usual social roles, sexual roles, and communica- tion), psychological function (including mood and emo- tional components), physical abilities (such as mobility, physical activity, and ability for self-care), and impair- ments (which take into account sensory functions and symptoms) (7). HRQOL assessment may be combined with survival data in order to merge morbidity and mortality impacts into a single measure. In many industrialized countries, length of life has been steadily increasing over the past century. This is in part due to improvements in hygiene and nutrition as well as preventative medicine and more effective disease-specific medical intervention. Therefore, similar to other medical domains, when assessing a new Acad Radiol 2007; 14:411– 419 1 From the Department of Radiology, University of Michigan, 1500 East Medical Center Drive, B2 A209, Ann Arbor, MI 48109-0030 (A.Z.K., R.C.C.); and National Cancer Institute of Canada, Clinical Trials Group, Queen’s University, 10 Stuart Street, Kingston, Ontario, Canada. K7L 3N6 (R.H.E.). Received Oct 4, 2006; accepted Jan 6, 2007. Address correspondence to: A.Z.K. e-mail: aniakielar@gmail.com © AUR, 2007 doi:10.1016/j.acra.2007.01.003 411