Geeta Bhagia1,2, Sanjay Kumar3. 1. Internal Medicine, Benefis Health System, Great Falls, USA. 2. Internal Medicine, Monmouth Medical Center, Long Branch, USA. 3. Hospitalist, Benefis Health System, Great Falls, USA.
Abstract
BACKGROUND: Diffusion-weighted MRI is shown to be equally effective, as a CT scan, in diagnosing ischemic and hemorrhagic strokes. Would it be cost-effective to perform an early MRI instead of a CT head? METHODS: A retrospective chart review was conducted between October 1, 2015, through October 1, 2017, for patients admitted for possible cerebrovascular accident (CVA). Inclusion criteria were age >/= 18 years and symptoms suggestive of a stroke. Exclusion criteria were pregnancy and age <18 years. We obtained information regarding patients' length of hospital stay, imaging modalities performed, and the related cost. We performed a cost analysis by calculating the total duration and cost of hospitalization, and cost for each investigation. RESULTS: The study included 828 patients who underwent CT head without contrast initially. A total of 634 (76.5%) patients got MRI brain without contrast, 261 (31.5%) had MRI brain with and without contrast, 406 (49%) had magnetic resonance angiography (MRA) head without contrast, 60 patients (7.2%) had MRA neck without contrast, 272 (32.8%) had MRA neck with and without contrast, and 1 patient (0.1%) had MRA head with and without contrast. The hospital duration for all patients was 1,797 days. The average duration per patient was 1.9364 days. The total health care cost for all patients was $25,383,983. Average per patient hospitalization cost was $25,383,983/828 = $30656.98. Average per day cost for all patients would be $25383983/1.93days = $13,152,322.8. Combined costs of all MRIs performed on all patients = $1,413,014. If MRI brain with and without contrast was considered as an initial modality, a total of $335,340 can be saved on the diagnostic imaging. Ultimately, it can also help reduce the hospitalization duration. CONCLUSION: Early MRI (in appropriately selected patients) can reduce the length of hospitalization and cut some health care costs. However, more studies are required to develop appropriate patient selection criteria.
BACKGROUND: Diffusion-weighted MRI is shown to be equally effective, as a CT scan, in diagnosing ischemic and hemorrhagic strokes. Would it be cost-effective to perform an early MRI instead of a CT head? METHODS: A retrospective chart review was conducted between October 1, 2015, through October 1, 2017, for patients admitted for possible cerebrovascular accident (CVA). Inclusion criteria were age >/= 18 years and symptoms suggestive of a stroke. Exclusion criteria were pregnancy and age <18 years. We obtained information regarding patients' length of hospital stay, imaging modalities performed, and the related cost. We performed a cost analysis by calculating the total duration and cost of hospitalization, and cost for each investigation. RESULTS: The study included 828 patients who underwent CT head without contrast initially. A total of 634 (76.5%) patients got MRI brain without contrast, 261 (31.5%) had MRI brain with and without contrast, 406 (49%) had magnetic resonance angiography (MRA) head without contrast, 60 patients (7.2%) had MRA neck without contrast, 272 (32.8%) had MRA neck with and without contrast, and 1 patient (0.1%) had MRA head with and without contrast. The hospital duration for all patients was 1,797 days. The average duration per patient was 1.9364 days. The total health care cost for all patients was $25,383,983. Average per patient hospitalization cost was $25,383,983/828 = $30656.98. Average per day cost for all patients would be $25383983/1.93days = $13,152,322.8. Combined costs of all MRIs performed on all patients = $1,413,014. If MRI brain with and without contrast was considered as an initial modality, a total of $335,340 can be saved on the diagnostic imaging. Ultimately, it can also help reduce the hospitalization duration. CONCLUSION: Early MRI (in appropriately selected patients) can reduce the length of hospitalization and cut some health care costs. However, more studies are required to develop appropriate patient selection criteria.
Authors: Julio A Chalela; Chelsea S Kidwell; Lauren M Nentwich; Marie Luby; John A Butman; Andrew M Demchuk; Michael D Hill; Nicholas Patronas; Lawrence Latour; Steven Warach Journal: Lancet Date: 2007-01-27 Impact factor: 79.321
Authors: Emelia J Benjamin; Michael J Blaha; Stephanie E Chiuve; Mary Cushman; Sandeep R Das; Rajat Deo; Sarah D de Ferranti; James Floyd; Myriam Fornage; Cathleen Gillespie; Carmen R Isasi; Monik C Jiménez; Lori Chaffin Jordan; Suzanne E Judd; Daniel Lackland; Judith H Lichtman; Lynda Lisabeth; Simin Liu; Chris T Longenecker; Rachel H Mackey; Kunihiro Matsushita; Dariush Mozaffarian; Michael E Mussolino; Khurram Nasir; Robert W Neumar; Latha Palaniappan; Dilip K Pandey; Ravi R Thiagarajan; Mathew J Reeves; Matthew Ritchey; Carlos J Rodriguez; Gregory A Roth; Wayne D Rosamond; Comilla Sasson; Amytis Towfighi; Connie W Tsao; Melanie B Turner; Salim S Virani; Jenifer H Voeks; Joshua Z Willey; John T Wilkins; Jason Hy Wu; Heather M Alger; Sally S Wong; Paul Muntner Journal: Circulation Date: 2017-01-25 Impact factor: 29.690
Authors: Gregory W Albers; Michael P Marks; Stephanie Kemp; Soren Christensen; Jenny P Tsai; Santiago Ortega-Gutierrez; Ryan A McTaggart; Michel T Torbey; May Kim-Tenser; Thabele Leslie-Mazwi; Amrou Sarraj; Scott E Kasner; Sameer A Ansari; Sharon D Yeatts; Scott Hamilton; Michael Mlynash; Jeremy J Heit; Greg Zaharchuk; Sun Kim; Janice Carrozzella; Yuko Y Palesch; Andrew M Demchuk; Roland Bammer; Philip W Lavori; Joseph P Broderick; Maarten G Lansberg Journal: N Engl J Med Date: 2018-01-24 Impact factor: 91.245
Authors: William J Powers; Alejandro A Rabinstein; Teri Ackerson; Opeolu M Adeoye; Nicholas C Bambakidis; Kyra Becker; José Biller; Michael Brown; Bart M Demaerschalk; Brian Hoh; Edward C Jauch; Chelsea S Kidwell; Thabele M Leslie-Mazwi; Bruce Ovbiagele; Phillip A Scott; Kevin N Sheth; Andrew M Southerland; Deborah V Summers; David L Tirschwell Journal: Stroke Date: 2018-01-24 Impact factor: 7.914
Authors: Raul G Nogueira; Ashutosh P Jadhav; Diogo C Haussen; Alain Bonafe; Ronald F Budzik; Parita Bhuva; Dileep R Yavagal; Marc Ribo; Christophe Cognard; Ricardo A Hanel; Cathy A Sila; Ameer E Hassan; Monica Millan; Elad I Levy; Peter Mitchell; Michael Chen; Joey D English; Qaisar A Shah; Frank L Silver; Vitor M Pereira; Brijesh P Mehta; Blaise W Baxter; Michael G Abraham; Pedro Cardona; Erol Veznedaroglu; Frank R Hellinger; Lei Feng; Jawad F Kirmani; Demetrius K Lopes; Brian T Jankowitz; Michael R Frankel; Vincent Costalat; Nirav A Vora; Albert J Yoo; Amer M Malik; Anthony J Furlan; Marta Rubiera; Amin Aghaebrahim; Jean-Marc Olivot; Wondwossen G Tekle; Ryan Shields; Todd Graves; Roger J Lewis; Wade S Smith; David S Liebeskind; Jeffrey L Saver; Tudor G Jovin Journal: N Engl J Med Date: 2017-11-11 Impact factor: 91.245
Authors: M A Kumar; H Vangala; D C Tong; D M Campbell; A Balgude; I Eyngorn; A S Beraud; J M Olivot; A W Hsia; R A Bernstein; C A Wijman; M G Lansberg; M Mlynash; S Hamilton; M E Moseley; G W Albers Journal: J Neurol Neurosurg Psychiatry Date: 2011-05-07 Impact factor: 10.154
Authors: Tudor G Jovin; Jeffrey L Saver; Marc Ribo; Vitor Pereira; Anthony Furlan; Alain Bonafe; Blaise Baxter; Rishi Gupta; Demetrius Lopes; Olav Jansen; Wade Smith; Daryl Gress; Steven Hetts; Roger J Lewis; Ryan Shields; Scott M Berry; Todd L Graves; Tim Malisch; Ansaar Rai; Kevin N Sheth; David S Liebeskind; Raul G Nogueira Journal: Int J Stroke Date: 2017-06-01 Impact factor: 5.266