Study: CT, MRI use dropped after 2005

The increase in the use of magnetic resonance imaging and computed tomography for patients in the U.S. slowed to between 1% and 3% per year between 2006 and 2009, ending a decade of growth that had exceeded 6% annually, according to a study published online in Health Affairs (July 25, 2012).

To analyze the trends in utilization, co-authors David W. Lee, of GE Healthcare, Waukesha, WI, and Frank Levy, of the Massachusetts Institute of Technology and Harvard Medical School, Boston, examined claims data for both the Medicare and non-Medicare patients from 2000 to 2009.

For the Medicare population, use of CT grew at an annual rate of 14.3% from 2000 to 2005; the growth rate began declining each year after 2005, to the lowest increase of 1.4% in 2009. MRI use in Medicare slowed from 14% annual growth between 2000 and 2005 to an average of 2.6% during 2006-09. Among the commercially insured nonelderly population, the study detailed similar utilization slowdowns.

"We hypothesize that higher cost sharing, prior authorization, reduced reimbursements, and fear of radiation are, for different parts of the population, countering some of the nonmedical incentives to order an imaging study," the authors concluded. "What has occurred in the imaging field suggests incentive-based cost control measures can be a useful complement to comparative effectiveness research when a procedure’s ultimate clinical benefit is uncertain."

In a statement about the study, the American College of Radiology said the list of factors cited for the decline is incomplete and the drop in imaging use is not without adverse consequences.

"Imaging utilization has tightened due to a number of factors, including greater use of evidence-based ACR Appropriateness Criteria and electronic physician order entry systems based on these guidelines, which ensure that patients get the right scan for the right indication," the statement said. "These tools have been shown to improve quality, reduce unnecessary scans, and lower imaging costs. Efforts, such as Image Gently and Image Wisely, have made providers aware of opportunities to reduce radiation from imaging exams and reduce unnecessary use of scans.

"In addition, increasing numbers of imaging facilities are becoming ACR accredited, which helps improve quality and reduce duplicate scanning due to poor quality images. These efforts have undoubtedly contributed to lower utilization."

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