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Conventional Radiography, Rapid MR Imaging, and Conventional MR Imaging for Low Back Pain: Activity-based Costs and Reimbursement¹

¹ From the Depts of Pediatrics (D.T.G.), Radiology (W.H., C.C.B., M.A.A., B.I.M., J.G.J.), Neurosurgery (J.G.J.), and Internal Medicine (R.A.D.) of the School of Medicine; Dept of Health Services (D.T.G., W.H., S.D.S., R.A.D., J.G.J.) of the School of Public Health and Community Medicine; School of Pharmacy (S.D.S.), and Center for Cost and Outcomes Research (D.T.G., W.H., B.I.M., S.D.S., R.A.D., J.G.J.), Univ of Washington, 146 N Canal St, Suite 300, Seattle, WA 98103; and Dept of Public Health and Primary Care, Univ of Cambridge, England (W.H.). Received Jan 29, 2002; revision requested Mar 22; revision received Sep 18; accepted Oct 14. Supported by Agency for Healthcare Research and Quality grant nos. RO1 HS09499, RO1 HS09499 S1, and 1K08 HS11291-01, and by National Institute of Arthritis and Musculoskeletal and Skin Diseases grant no. 1 P60 AR48093-01. Address correspondence to D.T.G. (e-mail: tolvadtg@u.washington.edu).

PURPOSE: To incorporate personnel and equipment use time in an activity-based cost comparison of conventional radiography and conventional and rapid magnetic resonance (MR) imaging for low back pain (LBP).

MATERIALS AND METHODS: At each of four Seattle Lumbar Imaging Project (SLIP) sites, patients were randomized to undergo conventional radiography or rapid MR imaging of the lumbar spine. For sample SLIP patients and for similar non-SLIP patients undergoing conventional lumbar spine MR imaging as usual care in calendar year 2000, measured imaging room use and technologist and radiologist times were multiplied by costs per minute of standard equipment acquisition, personnel compensation, and related expenses. Resulting provider-perspective costs and Seattle area Medicare reimbursements for conventional MR imaging and radiography for calendar year 2001 were used to estimate future "normative" reimbursement for rapid MR imaging.

RESULTS: For 23 conventional radiography, 27 rapid MR imaging, and 38 conventional MR imaging examinations timed in calendar year 2000, all rapid MR imaging times exceeded those of conventional radiography but were less than those of conventional MR imaging. All 0.3- and 0.35-T MR imaging room and technologist times exceeded those for 1.5-T MR imaging. Average costs (in 2001 dollars) were $44 for conventional radiography, $126 for 1.5-T rapid MR imaging, $128 for 0.3–0.35-T rapid MR imaging, $267 for 1.5-T conventional MR imaging, and $264 for 0.3–0.35-T conventional MR imaging. Conclusions regarding cost differences between conventional radiography and rapid MR imaging were robust to plausible parameter value changes evaluated in sensitivity analyses. Conventional radiography reimbursement was $44. Applying the ratio of reimbursement ($620) to costs ($264–$267) for conventional MR imaging to rapid MR imaging costs predicted reimbursement of $292–$300 for the new modality.

CONCLUSION: Times and costs for rapid MR imaging are roughly three times those for conventional radiography but about half those for conventional MR imaging for LBP. While current conventional radiography costs exceed reimbursement, current conventional MR and projected rapid MR imaging reimbursements exceed costs.

© RSNA, 2003

Index terms: Cost effectiveness • Economics, medical • Radiology and radiologists, socioeconomic issues • Spine, MR, 33.12141, 33.121416 • Spine, radiography, 33.11