Author: Marty Stempniak

Head and neck cancer patients are paying tens of thousands of dollars for unnecessary imaging surveillance and radiologist professional charges, according to a new single-center analysis published Thursday.

The National Comprehensive Cancer Network recommends follow-up imaging within six months after treatment for the disease, with further scans necessary only if patients show any signs of recurrence. Yet, providers often subject asymptomatic individuals to repeated rounds of costly imaging anyway, experts noted in JAMA Otolaryngology–Head & Neck Surgery.

Wanting to understand this concern at their own institution, NorthShore University HealthSystem looked to the data. Across 136 patients treated for head and neck cancer, the average individual received 14 imaging studies during a surveillance period of 3.2 years at an average cost of $36,800. Patients who lacked any symptoms received four imaging exams each year at an annual cost of $9,600, the authors concluded. Only 10.3% of patients developed a recurrence.

“One could argue that such examinations were unnecessary and clearly not cost-effective,” Cheryl Nocon, MD, an otolaryngologist who worked with NorthShore at the time of the study but now practices in Los Angeles, and co-authors wrote May 13. “The amount of money spent on imaging in patients who ultimately proved to be disease free is substantial and should be carefully considered in the context of the current healthcare financial setting.”

The Evanston, Illinois-based hospital system certainly isn’t alone. One recent study pegged annual U.S. spending on head and neck cancers at $4.2 billion, with per-individual expenditures similar to cancers such as lung and colon that are far more prevalent, Nocon et al. noted.

For their study, researchers retrospectively reviewed records for adult patients newly diagnosed with and treated for mucosal and salivary gland malignant tumors between 2010 and 2016. The initial scan found 435 patients, whittled down to 136 when excluding those with incomplete medical records, metastatic disease, or who left the system. Nocon and co-authors targeted CPT codes for neck imaging using ultrasound, CT and MRI, along with chest and maxillofacial computed tomography, among others.

NorthShore patients who remained disease-free received an average of 13 imaging studies during the surveillance period at a cost of $35,000. Those without symptoms had four studies per year at an average annual cost of $9,600. Patients who developed a recurrence had more studies per year of follow-up (average difference of five) and higher associated average costs (difference of $10,600) than those who remained disease free.

“These costs included not only the ordered imaging examinations but also the associated expenses of ordering and interpreting the examination findings, such as laboratory charges for required blood tests, hospital charges, and professional charges of the radiologists who read the images,” the authors noted. “To the best of our knowledge, this is the first study of the direct costs associated with surveillance imaging in this population, and it sheds light on the potential for cost savings in the current health care environment,” they added.

The study is limited by its retrospective nature and possible inaccurate documentation of indications for imaging exams, which could artificially inflate cost estimates. Read the rest of the study in JAMA here.

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