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Study: Unneeded Head Scans Cost Millions

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Medically unnecessary CT and MRI head scans of headache patients cost the U.S. health care system hundreds of millions of dollars a year, according to a new study published online Monday in JAMA Internal Medicine.

The researchers counted 51.1 million adult patient visits to physicians for headaches from 2007 through 2010, nearly half of them for migraines. Of those visits, 12.4 percent resulted in a brain MRI or CT—despite the fact that, as the study says, “The yield of significant abnormalities on neuroimaging patients with chronic headaches is 1% to 3%.”

The study’s lead author, Brian Callaghan, MD, a neurologist, elaborated:

Lots of guidelines say we shouldn’t do this—including ones from neurology and radiology groups—but yet we still do it a lot. This is a source of tremendous cost in health care without a lot of evidence to justify the cost.

Dr. Callaghan is an assistant professor of neurology at the University of Michigan. He was quoted in a university news release.

The study put the cost of the scans alone, not counting any associated tests or treatments, at nearly $1 billion a year. “But doctors typically don’t consider costs, and patients usually aren’t paying directly for these scans,” Dr. Callaghan said. “Insurers may require prior authorizations but still cover the scans if they are ordered.”

He told NPR, for its Shots health blog, “Most headaches are not caused by something bad. Even people with brain tumors rarely have headaches.”

So then why has the incidence of such scans increased for headache patients, even after the publication of guidelines discouraging their use?

Dr. Callaghan said some patients worry that their headaches may have dire causes, and some doctors worry that they’ll get sued if they turn down a patient’s request and it turns out there really is some neurological abnormality.

But things don’t have to be that way, he said. “I actually find that most patients are quite reasonable if you’re willing to explain all the things that went into deciding why not to get a scan,” he told NPR.

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