During the recent health care debate, the rising costs of health care were frequently discussed. Many theories exist as to what is driving these costs upwards, with common targets of blame being tests done for defensive medicine purposes, increased use of new imaging techniques, and the rising costs of prescription medication. Few research studies, however, have actually investigated these issues. A paper published today in the Journal of the American Medical Association, took on the issue of the use and costs of imaging tests, such as CTs, MRIs, and PET scans, is skyrocketing.
Who was studied? Did they have more imaging tests? The authors of the study examined the changing use and costs of diagnostic imaging from 1999-2006 in patients with cancer. They studied a portion of Medicare patients who were diagnosed in that time period with the most common cancers, including lung, breast, colon and prostate cancers. The number of imaging procedures increased for just about every type of imaging procedure studied, with the exception of standard X-rays. Most notably, the rate of extremely expensive PET scans increased anywhere from 35 percent to 54 percent each year.
Did this increase affect the cost of treating the patients? Definitely. The total cost of cancer care increased between 1.8 percent and 4.6 percent per year, while the cost of imaging increased from 5.1 percent to 10.3 percent per year. Thus the rate of growth of imaging rapidly outpaced the overall cost of caring for these patients. In absolute terms, the costs of imaging each patient at least doubled from 1999 to 2006 in almost every cancer that was studied.
So we doubled the cost of imaging these patients. Did this result in better care? This question was not addressed in this study. It is possible that the cancer staging was more accurate or recurrences were detected earlier. If so, the increased costs could be justified. But we don't know whether this occurred, and even if it did, we don't know that it would result in better outcomes. We do know, however, that many imaging tests currently being ordered are unnecessary. My research group at Mount Sinai Medical Center in New York is actually studying this issue in regards to prostate cancer right now, and our research will be published soon.
Why does it matter how much we spend on imaging? As was clear in the debate over the health care law, the rising costs of health care are a significant problem for the government and overall economy. This study demonstrates that advanced imaging technologies are responsible for a significant portion of the increases in health care costs in the country. Controlling these costs would go a long way toward controlling overall health care costs. By not ordering unnecessary, expensive imaging procedures, we as doctors can help do our part. I am also afraid that most of these tests are being ordered due to defensive practice of medicine and physicians protecting themselves against unnecessary law suits which need to be addressed as well.
David B. Samadi, MD is the Chief of Robotics and Minimally Invasive Surgery at Mount Sinai School of Medicine in New York City. As a board-certified urologist and an oncologist specializing in the diagnosis and treatment of urologic diseases, kidney cancer, bladder cancer, and prostate cancer, he also specializes in many advanced minimally invasive treatments for prostate cancer, including laparoscopic radical prostatectomy and laparoscopic robotic radical prostatectomy. His Web site, Robotic Oncology, has been translated into six different languages and is one of the most popular urology sites on the Internet.
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