Economic consequences of diagnostic imaging for vocal cord paralysis

Acad Radiol. 2001 Feb;8(2):137-48. doi: 10.1016/s1076-6332(01)90076-5.

Abstract

Rationale and objectives: The purpose of this retrospective study was to estimate the economic consequences of evaluating suspected vocal cord paralysis with magnetic resonance (MR) imaging and computed tomography (CT).

Materials and methods: Reports from MR imaging (n = 30) or CT (n = 19) studies of the neck in 49 patients were retrospectively reviewed for causes of vocal cord paralysis. The patients were divided into high-suspicion (n = 20) and low-suspicion (n = 29) groups, based on the presence or absence of a clinically detectable abnormality other than vocal cord immobility. Clinic and inpatient charts were examined to determine the work-up in all cases. The Medicare Resource-based Relative Value Scale was used to estimate the costs of most procedures.

Results: The high-clinical-suspicion group included nine true-positive, four false-positive, seven true-negative, and no false-negative cases. Further work-up was performed in seven true-positive, three false-positive, and one true-negative cases. The total cost of immediate diagnostic work-up in these 20 patients, including MR imaging and/or CT, was $20,737 ($2,304 per true-positive case). The low-suspicion group included two true-positive, nine false-positive, 18 true-negative, and no false-negative cases. Further work-up was performed in both true-positive, four false-positive, and two true-negative cases. The total cost of immediate diagnostic work-up in these 29 patients was $21,698, (mean, $748; $10,849 per true-positive case).

Conclusion: The average cost of finding space-occupying lesions in patients with vocal cord paralysis is more than 4.5 times higher in patients without suspicious antecedent clinical findings than in those with such a history. The benefits of obtaining negative findings and of detecting a small number of space-occupying lesions should be weighed against the costs of such examinations and of additional work-up for false-positive findings.

MeSH terms

  • Algorithms
  • Cost-Benefit Analysis
  • False Positive Reactions
  • Humans
  • Magnetic Resonance Imaging / economics*
  • Medicare
  • Predictive Value of Tests
  • Relative Value Scales
  • Retrospective Studies
  • Sensitivity and Specificity
  • Tomography, X-Ray Computed / economics*
  • United States
  • Vocal Cord Paralysis / diagnosis*
  • Vocal Cord Paralysis / diagnostic imaging
  • Vocal Cord Paralysis / economics*
  • Vocal Cord Paralysis / etiology