Rationale and Objectives
To review US health care trends related to medical imaging utilization and costs as well as to present standard methods for conducting economic evaluation for health care interventions and medical imaging specifically.
Materials and Methods
A review of the medical literature was performed to assess health policy and health technology assessment trends, expenditures, and cost-effectiveness analysis (CEA) related to medical imaging. Standard approaches to conducting economic evaluation and cost-effectiveness analysis were reviewed and summarized. Examples of CEA evidence related to imaging in select oncology conditions were presented.
Results
Several high-quality methodology publications have provided guidance for conducting economic evaluation and CEA in radiology. There is variability in the quality of CEA models and their dissemination. However, there are numerous methodologically sound cost-effectiveness analyses for radiology procedures, and the evidence base of CEA studies for medical imaging continues to increase. Advanced imaging approaches for diagnosing and staging oncology conditions have the potential to provide cost-effective care when used in appropriate patient subpopulations.
Conclusions
Additional rigorous comparative effectiveness studies for advanced imaging, including cost-effectiveness analyses, can provide useful information to policy makers and health care providers on the relative effects and costs associated with diagnostic alternatives.
Rapid technology improvement and the associated increases in medical costs have led health care reimbursement agencies and health insurance companies to engage more seriously in health technology assessment . State agencies are performing assessments , federal agencies are reviewing and reporting on comparative evidence , and international bodies are actively engaged . A 2009 Kaiser Family Foundation publication indicated that between 1999 and 2008, health insurance premiums cumulatively increased by 119% compared with cumulative growth of 29% for general consumer prices and cumulative wage growth of 34%, indicating an unsustainable trend .
During recent decades, diagnostic capabilities have improved immensely with computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET). However, in 2008, McKinsey & Company reported that the United States has more CT scanners and MRI machines per million people than nearly all high-income countries, that the technologies are used more than most other countries, and that the average reimbursement amount per procedure is several times greater than other countries (eg, Japan, Germany). To address issues related to medical imaging growth, a 2008 special edition of Health Affairs was devoted to assessing the utilization, costs, and policy recommendations for using medical imaging appropriately .
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Background: The health care environment for comparative evaluations in imaging
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Basic concepts and challenges for performing economic evaluation in health care
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Applying cost-based analyses to health care interventions
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Primary considerations for designing and conducting CEA or CUA
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Economic evaluation issues specific to radiology
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Reviews of CEA evidence for radiology
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Imaging CEAs and CUAs: Examples in oncology
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Discussion
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Acknowledgment
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