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Diagnostic Needle Arthroscopy and the Economics of Improved Diagnostic Accuracy: A Cost Analysis
BACKGROUND: Hundreds of thousands of surgical arthroscopy procedures are performed annually in the United States (US) based on MRI findings. There are situations where these MRI findings are equivocal or indeterminate and because of this clinicians commonly perform the arthroscopy in order not to mi...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Springer International Publishing
2014
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4175434/ https://www.ncbi.nlm.nih.gov/pubmed/25015766 http://dx.doi.org/10.1007/s40258-014-0109-6 |
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author | Voigt, Jeffrey D. Mosier, Michael Huber, Bryan |
author_facet | Voigt, Jeffrey D. Mosier, Michael Huber, Bryan |
author_sort | Voigt, Jeffrey D. |
collection | PubMed |
description | BACKGROUND: Hundreds of thousands of surgical arthroscopy procedures are performed annually in the United States (US) based on MRI findings. There are situations where these MRI findings are equivocal or indeterminate and because of this clinicians commonly perform the arthroscopy in order not to miss pathology. Recently, a less invasive needle arthroscopy system has been introduced that is commonly performed in the physician office setting and that may help improve the accuracy of diagnostic findings. This in turn may prevent unnecessary follow-on arthroscopy procedures from being performed. OBJECTIVE: The purpose of this analysis is to determine whether the in-office diagnostic needle arthroscopy system can provide cost savings by reducing unnecessary follow on arthroscopy procedures. METHODS: Data obtained from a recent trial and from a systematic review were used in comparing the accuracy of MRI and VisionScope needle arthroscopy (VSI) with standard arthroscopy (gold standard). The resultant false positive and false negative findings were then used to evaluate the costs of follow-on procedures. These differences were then modeled for the US patient population diagnosed and treated for meniscal knee pathology (most common disorder) to determine if a technology such as VSI could save the US healthcare system money. Data on surgical arthroscopy procedures in the US for meniscal knee pathology were used (calendar year [CY] 2010). The costs of performing diagnostic and surgical arthroscopy procedures (using CY 2013 Medicare reimbursement amounts), costs associated with false negative findings, and the costs for treating associated complications arising from diagnostic and therapeutic arthroscopy procedures were assessed. RESULTS: In patients presenting with medial meniscal pathology (International Classification of Diseases, 9th edition, Clinical Modification [ICD9CM] diagnosis 836.0), VSI in place of MRI (standard of care) resulted in a net cost savings to the US system of US$115–US$177 million (CY 2013) (use of systematic review and study data, respectively). In patients presenting with lateral meniscus pathology (ICD9CM 836.1), VSI in place of MRI cost the healthcare system an additional US$14–US$97 million (CY 2013). Overall aggregate savings for meniscal (lateral plus medial) pathology were identified in representative care models along with more appropriate care as fewer patients were exposed to higher risk surgical procedures. CONCLUSIONS: Since in-office arthroscopy is significantly more accurate, patients can be treated more appropriately and the US healthcare system can save money, most especially in medial meniscal pathology. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s40258-014-0109-6) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-4175434 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2014 |
publisher | Springer International Publishing |
record_format | MEDLINE/PubMed |
spelling | pubmed-41754342014-09-30 Diagnostic Needle Arthroscopy and the Economics of Improved Diagnostic Accuracy: A Cost Analysis Voigt, Jeffrey D. Mosier, Michael Huber, Bryan Appl Health Econ Health Policy Original Research Article BACKGROUND: Hundreds of thousands of surgical arthroscopy procedures are performed annually in the United States (US) based on MRI findings. There are situations where these MRI findings are equivocal or indeterminate and because of this clinicians commonly perform the arthroscopy in order not to miss pathology. Recently, a less invasive needle arthroscopy system has been introduced that is commonly performed in the physician office setting and that may help improve the accuracy of diagnostic findings. This in turn may prevent unnecessary follow-on arthroscopy procedures from being performed. OBJECTIVE: The purpose of this analysis is to determine whether the in-office diagnostic needle arthroscopy system can provide cost savings by reducing unnecessary follow on arthroscopy procedures. METHODS: Data obtained from a recent trial and from a systematic review were used in comparing the accuracy of MRI and VisionScope needle arthroscopy (VSI) with standard arthroscopy (gold standard). The resultant false positive and false negative findings were then used to evaluate the costs of follow-on procedures. These differences were then modeled for the US patient population diagnosed and treated for meniscal knee pathology (most common disorder) to determine if a technology such as VSI could save the US healthcare system money. Data on surgical arthroscopy procedures in the US for meniscal knee pathology were used (calendar year [CY] 2010). The costs of performing diagnostic and surgical arthroscopy procedures (using CY 2013 Medicare reimbursement amounts), costs associated with false negative findings, and the costs for treating associated complications arising from diagnostic and therapeutic arthroscopy procedures were assessed. RESULTS: In patients presenting with medial meniscal pathology (International Classification of Diseases, 9th edition, Clinical Modification [ICD9CM] diagnosis 836.0), VSI in place of MRI (standard of care) resulted in a net cost savings to the US system of US$115–US$177 million (CY 2013) (use of systematic review and study data, respectively). In patients presenting with lateral meniscus pathology (ICD9CM 836.1), VSI in place of MRI cost the healthcare system an additional US$14–US$97 million (CY 2013). Overall aggregate savings for meniscal (lateral plus medial) pathology were identified in representative care models along with more appropriate care as fewer patients were exposed to higher risk surgical procedures. CONCLUSIONS: Since in-office arthroscopy is significantly more accurate, patients can be treated more appropriately and the US healthcare system can save money, most especially in medial meniscal pathology. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s40258-014-0109-6) contains supplementary material, which is available to authorized users. Springer International Publishing 2014-07-12 2014 /pmc/articles/PMC4175434/ /pubmed/25015766 http://dx.doi.org/10.1007/s40258-014-0109-6 Text en © The Author(s) 2014 https://creativecommons.org/licenses/by-nc/4.0/ Open AccessThis article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited. |
spellingShingle | Original Research Article Voigt, Jeffrey D. Mosier, Michael Huber, Bryan Diagnostic Needle Arthroscopy and the Economics of Improved Diagnostic Accuracy: A Cost Analysis |
title | Diagnostic Needle Arthroscopy and the Economics of Improved Diagnostic Accuracy: A Cost Analysis |
title_full | Diagnostic Needle Arthroscopy and the Economics of Improved Diagnostic Accuracy: A Cost Analysis |
title_fullStr | Diagnostic Needle Arthroscopy and the Economics of Improved Diagnostic Accuracy: A Cost Analysis |
title_full_unstemmed | Diagnostic Needle Arthroscopy and the Economics of Improved Diagnostic Accuracy: A Cost Analysis |
title_short | Diagnostic Needle Arthroscopy and the Economics of Improved Diagnostic Accuracy: A Cost Analysis |
title_sort | diagnostic needle arthroscopy and the economics of improved diagnostic accuracy: a cost analysis |
topic | Original Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4175434/ https://www.ncbi.nlm.nih.gov/pubmed/25015766 http://dx.doi.org/10.1007/s40258-014-0109-6 |
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