Areas of the United States with the highest number of MRIs have the highest incidence of surgery for lower-back pain, despite a lack of evidence showing that the surgeries are beneficial, Stanford researchers reported on Oct. 14 in the journal Health Affairs. Previous studies have shown that increased surgery rates for back pain do not improve patient outcomes, "so heading in this direction is concerning," said senior author Laurence Baker, a professor of health research and policy at Stanford University School of Medicine.
From 2000 to 2005, the availability of MRI scanners in the United States more than tripled, from 7.6 machines per 1 million people to 26.6 per million. A state-of-the-art scanner costs more than $2 million, so scans are expensive -- about $1,500 for one low-back scan. The increased use of the scanners and the growing number of surgeries that result from such scans are one component in the increase in health care costs, Baker said.
Baker and Jacqueline Baras, a medical student,obtained Medicare claim data from 1998 to 2005 for about 20 percent of patients with nonspecific low-back pain and compared it with data on the availability of MRI scanners, as determined by IMV Ltd., a health care consulting firm for the medical industry.
They found that the number of scans for low-back pain and the number of resulting surgeries in an area were directly proportional to the availability of scanners. About two-thirds of the scans, moreover, occurred in the first month after the onset of pain, despite clinical guidelines that recommend at least a one-month delay because of the large number of patients who spontaneously recover.
"The net result is increased risks of unnecessary surgery for patients and increased costs for everybody else," said Dr. John Birkmeyer, a professor of surgery at the University of Michigan who was not involved in the study.
About the study:
Using Medicare claims from 1998 to 2005, researchers examined 666,455 episodes of lower-back pain, of which 15.6 percent led to a lower-back MRI and 2.7 percent resulted in lower-back surgery within a year. When they broke the data up into 318 metropolitan statistical areas, they found the rates correlated directly with the local increase of MRI scanners.
Source: Thomas H. Maugh II, Tribune Newspapers
When this story was initially published on courant.com, it misreported the date of publication of the Stanford researchers' study.
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