A new JAMA Network Open study has unearthed significant increases in the use of unnecessary imaging to monitor noninvasive, low-grade bladder cancer.
Such disease is associated with “extremely low” rates of progress and mortality. Yet, providers often subject patients with low-risk, non-muscle-invasive bladder cancer to costly surveillance, which goes against treatment guidelines and provides no benefit, University of Texas experts wrote Friday.
Among more than 13,000 patients treated for this form of the disease, rates of upper tract imaging leapt from 30% in 2004 up to 47% by 2013. Most patients received a median of about two imaging scans per year, and the total cost of care per individual surged by 60% during that time frame, up to nearly $54,000.
“It was also notable that among all of the surveillance tests performed, CT and magnetic resonance imaging had the most significant increase in use (1.6-fold) over the study period,” first author Kelly Bree, MD, with the Department of Urology at the University of Texas MD Anderson Cancer Center in Houston, and colleagues wrote March 18. “In addition to the cost of these radiologic tests, CT urography, the most commonly performed CT imaging for upper tract surveillance, has been associated with at least a 1.5-fold increase in radiation dose compared with intravenous urography.”
Bree et al. conducted their study using data from the Surveillance, Epidemiology, and End Results–linked Medicare database. They pinpointed adults between the ages of 66-90, diagnosed with low-grade bladder tumors between 2004-2013. The use of kidney ultrasound also increased during study period, from 19% of patients up to 23.2%. Same for retrograde pyelography—an X-ray exam using contrast dye to examine the renal system—which increased from 20.9% in 2004 to 24.2% by the end of the study. Delivery of intravenous pyelography X-ray exams fell from 14.5% down to 1.7%, but there was a stepwise increase in CT and MRI in all years except 2010, the authors noted.
“The impact of these patterns is substantial and may have negative consequences for both patients and the healthcare system,” University of Texas Southwestern Medical Center experts wrote in a corresponding editorial. “Thus, it is imperative to move forward with initiatives that provide higher value and are more evidence-based and patient-centered.”
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.