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Imaging for LBP, lower extremity pain seen as a driver of increased health care costs
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According to a recently published study, the need for surgery is not common among patients who are newly diagnosed for low back pain and lower extremity pain; however, surgery is a significant reason for increased health care costs in this population.
"Many of these patients, though, had MRI or other imaging soon after the onset of their low back or leg pain,” John K. Ratliff, MD, told Healio.com/Orthopedics. “Imaging alone, without further interventions, accounted for a total of over half a billion dollars of spending annually, according to our study. These patients got better by themselves. They never needed any other intervention, meaning the MRI did not really add to their care.”
Researchers retrospectively analyzed a commercial database that contained inpatient and outpatient data and identified 2,498,013 patients with a new diagnosis of low back pain or lower extremity pain. They wanted to evaluate the use of health care resources and associated costs for low back pain and lower extremity pain. The total cost of care at 6 and 12 months was the primary outcome. Patients were stratified by whether they underwent surgery. Patients who did not undergo surgery were analyzed to determine whether they received care that was consistent with recommended guidelines for conservative management of low back pain and lower extremity pain. Investigators estimated costs of the different health care services used.
Results showed 55.7% of patients did not receive any intervention and 1.2% of patients underwent surgery. Patients who underwent surgery accounted for 29.3% of the $784 million in total costs after 12 months. Among the 98.8% of patients who did not undergo surgery, the total cost of care was $1.8 billion.
Investigators noted patients who did not undergo surgery often received care that was not consistent with guidelines for patients with low back pain and lower extremity pain. Of these patients, 32.3% of them received imaging within 30 days of diagnosis and 35.3% had no trial of physical therapy but received imaging. – by Monica Jaramillo
Disclosure: The study was supported by a grant from the Glen and Angela Charles Family Foundation.
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Kim LH, et al. JAMA Network Open. 2019;doi:10.1001/jamanetworkopen.2019.3676.
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