Downstream cost of incidental pancreatic cysts on MRI average $460 per finding

Researchers estimated the average downstream cost of incidental pancreatic cysts identified on MRI at $460 per finding, according to an Oct. 9 study published in the American Journal of Roentgenology. It may suggest a need for targeted efforts to promote greater guideline adherence.

Follow-up on incidental cysts can involve serial CT and MRI exams, endoscopic ultrasound-guided fine-needle aspiration along with tests and office visits, the authors wrote. However, these factors are rarely taken into account.

“The costs associated with such events are important to consider given the increasing and unsustainable expenditures of the U.S. health care system, the wide variability of care delivery, and the increasing federal mandate to focus on value in health care delivery to improve the nation's health care system,” wrote lead author Andrew B. Rosenkrantz, MD, MPA, with NYU Langone Medical Center in New York, and colleagues.

To investigate these costs, Rosenkrantz et al. examined the electronic medical record of 200 patients with incidental pancreatic cysts found during MRI, and identified downstream events such as imaging or office visits. The radiologists’ recommendations and ordering physician decisions were compared to the American College of Radiology (ACR) incidental findings committee recommendations.

Estimating costs using the national Medicare rates, the team found incidental findings averaged $460 per cyst. Additional findings are below:

  • Nine patients had a clinically relevant outcome during follow-up for a total per-cyst cost of $1364.
  • When physicians overmanaged relative to radiologist recommendations, costs were greater ($842 per finding) compared to when they followed guidelines ($631) or undermanaged ($252).
  • Relative to ACR recommendations, costs were lower when ordering physicians undermanaged ($252), but similar when adherent ($811) or overmanaged ($845).
  • Costs were similar whether radiologists recommended follow-up testing ($317-$491 per finding) compared to if they adhered to, undermanaged or overmanaged ($344-$528) based on the ACR's recommendations.

“We hope to catalyze a shift in thought process regarding such findings, whereby future investigators will also consider the economic effect and, hence, value of lesion follow-up when evaluating management algorithms for incidental findings,” the authors wrote. “If successful, such a shift will, in turn, foster greater evidence-based accountability by radiologists when encountering an incidental finding."

Additionally, Rosenkrantz and colleagues argued, although their results warrant further validation in larger studies, they point to a need for “targeted educational efforts, collaborative partnerships, and other initiatives to foster greater adherence to radiologist recommendations."