RSNA: Costs of incidental findings neither incidental nor insignificant

CHICAGO—With the number and frequency of incidentalomas on the rise, researchers have sought to quantify the economic impact of the finding and reported that followup can potentially double the cost of the index study depending on the frequency of the finding and the type of followup, according to a presentation on Nov. 30 at the 97th Scientific Assembly and Annual Meeting of the Radiological Society of North America.

“The economic impact of incidental findings are important and can be substantial,” said G. Scott Gazelle MD, MPH, PhD, professor in the department of health policy and management at Harvard Medical School in Boston.

“There is,” Gazelle said, “a wide spectrum of implications. The findings can benefit the patient by finding treatable disease earlier, or physicians can overdiagnose findings and work up benign findings or low-grade malignancies with no medical benefit to the patient.”

Gazelle noted that the economic implications can be substantial and outlined factors that influence the costs of incidental findings, which include:

• The type of imaging study;
• Patient gender and age;
• Frequency of  incidental findings;
• Perceived clinical significance;
• Type and number of follow-up studies; and
• Interventions, treatments and complications.

According to Gazelle, the costs of downstream recommendations add up. For example, Fleischner Society guidelines for the workup of pulmonary nodules call for as many as three follow-up nodules, depending on the size of the nodules and the patient’s risk.

However, few studies account for costs beyond the initial follow-up imaging exam and often omit other diagnostic testing and treatment costs. For example, studies estimating the follow-up costs of incidental findings detected during CT colonography exams estimates costs ranging from $13 to $282 and most are limited to imaging costs only.

Gazelle concluded by noting the lack of clear data on costs but did predict continued increasing costs as the use of cross sectional modalities grows.