Study: Redundant CT, MRI exams driving costs of stroke care

Neuroimaging practices for stroke patients may be unnecessarily costly and redundant, with substantial increases in MRI utilization supplementing, rather than replacing, CT use, according to a study published in the February edition of Annals of Neurology.

This redundancy has led neuroimaging to become the fastest growing component of hospitalization cost in stroke patients, according to James F. Burke, MD, of the department of neurology at the University of Michigan in Ann Arbor, and colleagues.

"Compared to CT, MRI is a more accurate test for stroke," Burke said in a statement. "But our results showed that MRI is not replacing CT as the primary stroke neuroimaging study—instead, patients are getting both.”

Findings were based on a serial cross-sectional study with time trends of neuroimaging in stroke patients across 10 states from 1999 to 2008. A total of 624,842 patients were hospitalized for stroke during the study period.

Results showed that absolute utilization of MRI increased 38 percent and relative utilization increased 235 percent (28 percent of stroke patients in 1999 compared with 66 percent in 2008). This increase varied greatly by state, and in 2008, MRI utilization for stroke ranged from a low of 55 percent in Oregon to a high of 79 percent in Arizona. On the other hand, CT utilization saw only a modest relative increase from 92 percent of strokes in 1999 to 95 percent in 2008.

“The wide geographic variation in MRI utilization demonstrates a potential opportunity to improve stroke care by increasing standardization,” wrote the authors. “This variation was not accounted for by measurable patient characteristics or hospital acquisition of MRI technology.”

Ninety-five percent of stroke patients who underwent MRI also had a CT scan, according to the authors.

The result of this doubling up on neuroimaging was a 42 percent increase in the cost of inpatient stroke care from 1997 to 2007, an increase of $3,800 per case. Diagnostic imaging costs in these cases rose 213 percent from 1999 to 2007.

"Minimizing the use of multiple studies could be a viable strategy to reduce costs," said Burke.

Neuroimaging practices in stroke are not standardized to recommend either MRI or CT, and doing so could improve efficiency in stroke care, according to the authors. "Understanding trends like these presented in this study are essential to determining efficient and consistent neuroimaging strategies," Burke said. "This represents an area where we have an opportunity to substantially reduce the cost of care without adversely affecting the quality of care."

In an accompanying editorial, Annals of Neurology Editor-in-Chief Stephen L. Hauser, MD, and Vice Editor S. Claiborne Johnston, MD, PhD, wrote that neurologists can no longer ignore rising healthcare costs and must set aside politics to work for a solution. They said the study from Burke et al provided a “startling demonstration of the physician’s role in rising healthcare costs,” and duplicate imaging in stroke is just one example of wasteful care.

“Given the economic realities of our healthcare system, if practitioners do not become engaged in the discussion, study and teaching of cost, others will ultimately place limits on our autonomy, and their decisions may not be as measured as our own,” wrote Hauser and Johnston.