Tuesday, December 19, 2006

Scanning: Who Pays?

A fellow journalist asked for information on screening scans, CT, MRI, Ultrasound exams, etc., like those increasingly being offered as ways to look for heart disease, cancer, and other diseases, without the risks of some other tests.

She wanted to know how much do they cost and who pays?

Well, leaving aside the serious issues of the thin or nonexistent evidence to show that scanning a healthy person is going to do more good than harm.

"Harm?," you ask. "Aren't these scans non-invasive?"

Well, other than the radiation dose from CT (which can add up), it's true that you are unlikely to be physically hurt by an imaging scan. But they can lighten your wallet, may not offer much useful information... and may send you into follow-up rounds of further (and possibly more hazardous) testing.

Here's some more of what I answered to the original query:

The costs vary widely, from a couple of hundred dollars to thousands, and insurance usually only pays when they are recommended by a physician to check on a suspected problem... not for screening healthy people. (Mammography being an exception.) A release from the Radiological Society of North America has some numbers and contact info: http://www2.rsna.org/pr/target.cfm?ID=235

One thing to include is the likelihood, costs and risks of follow-up investigations of screening scans. For one thing, screening scans almost always find something "abnormal."

Take a look at
http://radiology.rsnajnls.org/cgi/content/abstract/237/2/385?etoc

These researchers studied 1200 whole-body screening CT scans (about a third ordered by physicians, two-thirds self-referred by the customer). Almost 90% of scans resulted in at least one abnormal finding... and almost 40% of the people who got a screening scan were told they should have follow-up tests... usually more scans.

Who pays for the follow-up tests? And what if a "non-invasive" scan results in a recommendation of a biopsy or other invasive test?

A few years ago, Elliott Fishman, MD, at Johns Hopkins told me that if people decide to get screening scans that aren't recommended by a physician, then they should be responsible for the cost of follow-up, which may be tens of thousands of dollars. He said the cost of screening scans that aren't supported by evidence of effectiveness shouldn't be dumped on taxpayers and insurance premium payers. If you want to see his quote, go to: http://www.oncology-times.com/pt/pt-core/template-journal/oncotimes/media/HoltzWholeBodyCTScanning-PTFeb102003.pdf

And Bruce Hillman, MD, Chair of Radiology at the University of Virginia, has said that screening healthy people may cost $150,000 or more per year of life saved.

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