The results of a new study of about 20,000 Veterans Affairs system patients undergoing diagnostic imaging for peripheral vascular disease (PVD) from 1999 to 2004 show significant cost savings with contrast-enhanced magnetic resonance angiography (CE-MRA) as compared with digital subtraction angiography (DSA). The study also found that the Veterans Affairs system could have realized a cost savings of more than $13 million during the 6-year period if CE-MRA had been chosen over DSA for patients not requiring or planning follow-up procedures within 30 days.
This is the first research of its kind that looks at cost savings associated with imaging modalities in the VA system. The findings were presented today at the Ninth Annual European Congress of the International Society of Pharmacoeconomics and Outcomes Research in Copenhagen.
Led by J.W. Hay, PhD, Associate Professor of Pharmaceutical Economics and Policy at the University of Southern California in Los Angeles, the study, Cost Impact of Diagnostic Imaging of Lower Extremity Peripheral Vascular Disease (PVD), was conducted by a team of researchers from the VA Cooperative Studies (MAVERIC), Veterans Affairs Boston Healthcare System, Harvard Medical School, the University of Southern California and Berlex Laboratories.
"We were impressed with the magnitude of cost savings available with CE-MRA in these patients," says Hay. "In an era of cost containment, it is essential that clinicians and institutions be aware of the potential cost savings of various treatment and imaging modalities. While additional research is needed, our data show that for a substantial proportion of patients using CE-MRA as the initial imaging modality offers considerable cost savings, while providing optimum patient care."
Even after adjusting for endogenous choice of initial imaging modality, 30-day treatment costs per patient were $3,500 to $4,300 lower (p<0.001) for CE-MRA patients. The researchers concluded that had CE-MRA been chosen over DSA for patients not requiring or planning follow-up procedures within 30 days, the VA system could have realized a cost savings of $13.2 million during the 6-year period.
In their review of Veterans Affairs outpatient data from 1999 to 2004, researchers found that use of CE-MRA reduced imaging costs by 55 percent over DSA, going well beyond the $950 lower cost per imaging procedure. The majority of patients (16,026) underwent DSA versus 3,183 patients receiving CE-MRA during this period. Clinicians were more likely to choose CE-MRA for patients with prior renal disease or bypass surgery (OR >2; p.<001) and less likely among patients with prior amputation, PVD, claudication or other cardiovascular disease markers (OR<0.7; p< 001). The majority of MRA patients, 92 percent, required no additional procedures and experienced no events at 30 days, compared with 82 percent of DSA patients. At 90 days following the initial procedure, 76 percent of MRA patients had had no additional interventions or events as compared to 65 percent of DSA patients. Fewer than 3.2 percent of all patients had a repeat image at 30 days and only 3.6 percent of all patients required a repeat procedure at 90 days.