March 18, 2014
Unnecessary Brain Scans Are A Headache For Everyone
Brett Smith for redOrbit.com - Your Universe Online
Many people with persistent headaches are worried about a cancerous growth on their brain and request that their doctor perform and imaging scan, but more often than not – it’s not a tumor.
Because persistent headaches often have a more benign cause, US doctors perform around $1 billion worth of unnecessary and wasteful medical imaging tests, according to a new report from University of Michigan researchers that was published Monday in JAMA Internal Medicine.
The study team noted that quite a number of national recommendations for doctors expressly discourage scanning the brains of patients who complain of headache and migraines. Nevertheless, the new study reveals the pace of brain scans for headache has increased, not decreased, since these recommendations for doctors became available. This may imply that patient interest in CT or MRI scans drives a lot of the cost.
The new study is based on national information for headache-related visits to the doctor and adult neuroimaging tests. The research team computed estimated overall costs across a number of years.
Overall, 51 million headache-related patient appointments occurred between 2007 and 2010 – almost 50 percent were associated with migraine. A large proportion of these visits were by individuals under the age of 65 and over three-quarters of the sufferers were women. In those same four years, over 12 percent of these visits led to a brain MRI or CT scan.
The scientists approximated that the overall cost of the four years' worth of scans was about $3.9 billion, based on typical Medicare payouts to doctors for imaging.
"This is a conservative cost estimate based on what Medicare would pay for these tests. CTs and MRIs are commonly ordered for headache and migraine, and increasing over time, despite the fact that there are rare circumstances where imaging should be used," said Dr. Brian Callaghan, the U-M neurologist who led the team performing the study.
"Lots of guidelines say we shouldn't do this – including ones from neurology and radiology groups – but yet we still do it a lot,” he added. “This is a source of tremendous cost in health care without a lot of evidence to justify the cost.”
The study team suggested that doctors might order a CT or MRI scan for a patient who doesn’t meet high-risk criteria to put patients' minds at ease or to protect themselves legally. However, past research indicates that only one to three percent of scans of patients with recurring headaches show a tumor or blood vessel issue in the brain. Additionally, many of the issues that imaging tests spot end up never posing a significant threat – or might not require treatment quickly.
"There's solid research showing that the number of times you find serious issues on these scans in headache patients is about the same as that for a randomly chosen group of non-headache patients," he said. "And a lot of the things we find on such scans aren't necessarily something we will do something about."
Callaghan also said that the $1 billion a year bill doesn't include other costs, such as follow-up exams and any therapy that might be requested if a scan finds something. Also, CT imaging includes a radiation exposure, while MRI scans are more expensive and have a higher possibility of finding things that end up not being a problem.
"But doctors typically don't consider costs, and patients usually aren't paying directly for these scans," he noted. "Insurers may require prior authorizations but still cover the scans if they are ordered."