Is cardiac MRI stress imaging a cost-saving strategy for obese patients?
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ORAL PRESENTATION Open Access Is cardiac MRI stress imaging a cost-saving strategy for obese patients? J Ronald Mikolich 1,2* , John Lisko 1,2 , Brandon M Mikolich 2 From 17th Annual SCMR Scientific Sessions New Orleans, LA, USA. 16-19 January 2014 Background False positive nuclear stress myocardial perfusion ima- ging(MPI) findings are known to occur in obese patients and women with large breasts due to attenuation arti- fact. A false positive MPI study may lead to unnecessary coronary arteriography(Cath). CMR stress perfusion imaging is not affected by obesity and has better spatial resolution than MPI, without radiation exposure. The CE-MARC study showed superiority of CMR stress compared to MPI, but did not include patients > 120 kg (mean BMI = 29.2 kg/m2) due to magnet bore size lim- itations. This study was designed to assess the cost ben- efit of CMR stress as an alternative to MPI for obese patients with chest pain. Methods Concordance of MPI and Cath procedures were retro- spectively assessed from data in an institutional cardiac imaging database. MPI procedures were classified as Positive (at least 1 region of ischemia or infarction) or Negative (no ischemia or infarction). Cath procedures were classified as Positive (at least 1 stenosis > 70%) or Negative (no lesion > 70%). Concordance of MPI and CMR stress was assessed from a cohort of patients with both a CMR stress and a MPI within a 6 month time frame. There was no patient weight limit for either pro- cedure since a wide bore magnet was available for obese patients. Concordance for both patient cohorts were also analyzed by body mass index (BMI) < 25, 25-30, 30-35 and > 35 kg/m2.. From these data, using Medicare and private payor reimbursement data, analysis was carried out to compare the cost of the MPI versus cMRI stress perfusion strategies for obese patients with BMI > 35 kg/m2. Cost of Cath for false positive MPI and cMRI was included to assess the true cost of each strategy. Cost was computed assuming a patient popula- tion of 60% Medicare and 40% private insurance. Results The concordance rate of MPI and Cath for patients with a BMI > 35 kg/m2 was only 26%, indicating that 74% of patients with a BMI > 35 kg/m2 had a MPI which resulted in a Cath which may have not been necessary. The con- cordance of MPI and cMRI stress was similarly low, at only 21%(14% true positive). 84% of the discordant MPI-CMR patients had a false positive MPI, yielding a Cath rate of 30%. Using an MPI strategy, the cost per 100 patients was $418,237(or $4,182 per patient). Using a cMRI stress strategy, the cost per 100 patients was $193,617(or $1,936 per patient). Conclusions The majority of MPI procedures in obese patients result in false positive studies which lead to invasive coronary arter- iography for clarification. The high incidence of false posi- tivity is not observed with cMRI stress perfusion imaging. Although the per study cost of cMRI stress perfusion ima- ging is greater, the overall cost of the cMRI strategy is sig- nificantly less when compared to the MPI strategy for obese patients, due to the increased cost of Cath to evalu- ate false positive MPI studies. Cardiac MRI stress perfu- sion imaging is a cost-saving strategy for evaluation of obese patients with chest pain and suspected ischemia. Funding None. 1 NEOMED, Hermitage, Pennsylvania, USA Full list of author information is available at the end of the article Mikolich et al. Journal of Cardiovascular Magnetic Resonance 2014, 16(Suppl 1):O100 http://www.jcmr-online.com/content/16/S1/O100 © 2014 Mikolich et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Transcript of Is cardiac MRI stress imaging a cost-saving strategy for obese patients?
ORAL PRESENTATION Open Access
Is cardiac MRI stress imaging a cost-savingstrategy for obese patients?J Ronald Mikolich1,2*, John Lisko1,2, Brandon M Mikolich2
From 17th Annual SCMR Scientific SessionsNew Orleans, LA, USA. 16-19 January 2014
BackgroundFalse positive nuclear stress myocardial perfusion ima-ging(MPI) findings are known to occur in obese patientsand women with large breasts due to attenuation arti-fact. A false positive MPI study may lead to unnecessarycoronary arteriography(Cath). CMR stress perfusionimaging is not affected by obesity and has better spatialresolution than MPI, without radiation exposure. TheCE-MARC study showed superiority of CMR stresscompared to MPI, but did not include patients > 120 kg(mean BMI = 29.2 kg/m2) due to magnet bore size lim-itations. This study was designed to assess the cost ben-efit of CMR stress as an alternative to MPI for obesepatients with chest pain.
MethodsConcordance of MPI and Cath procedures were retro-spectively assessed from data in an institutional cardiacimaging database. MPI procedures were classified asPositive (at least 1 region of ischemia or infarction) orNegative (no ischemia or infarction). Cath procedureswere classified as Positive (at least 1 stenosis > 70%) orNegative (no lesion > 70%). Concordance of MPI andCMR stress was assessed from a cohort of patients withboth a CMR stress and a MPI within a 6 month timeframe. There was no patient weight limit for either pro-cedure since a wide bore magnet was available for obesepatients. Concordance for both patient cohorts werealso analyzed by body mass index (BMI) < 25, 25-30,30-35 and > 35 kg/m2.. From these data, using Medicareand private payor reimbursement data, analysis wascarried out to compare the cost of the MPI versuscMRI stress perfusion strategies for obese patients with
BMI > 35 kg/m2. Cost of Cath for false positive MPIand cMRI was included to assess the true cost of eachstrategy. Cost was computed assuming a patient popula-tion of 60% Medicare and 40% private insurance.
ResultsThe concordance rate of MPI and Cath for patients with aBMI > 35 kg/m2 was only 26%, indicating that 74% ofpatients with a BMI > 35 kg/m2 had a MPI which resultedin a Cath which may have not been necessary. The con-cordance of MPI and cMRI stress was similarly low, atonly 21%(14% true positive). 84% of the discordantMPI-CMR patients had a false positive MPI, yielding aCath rate of 30%. Using an MPI strategy, the cost per100 patients was $418,237(or $4,182 per patient). Using acMRI stress strategy, the cost per 100 patients was$193,617(or $1,936 per patient).
ConclusionsThe majority of MPI procedures in obese patients result infalse positive studies which lead to invasive coronary arter-iography for clarification. The high incidence of false posi-tivity is not observed with cMRI stress perfusion imaging.Although the per study cost of cMRI stress perfusion ima-ging is greater, the overall cost of the cMRI strategy is sig-nificantly less when compared to the MPI strategy forobese patients, due to the increased cost of Cath to evalu-ate false positive MPI studies. Cardiac MRI stress perfu-sion imaging is a cost-saving strategy for evaluation ofobese patients with chest pain and suspected ischemia.
FundingNone.
1NEOMED, Hermitage, Pennsylvania, USAFull list of author information is available at the end of the article
Mikolich et al. Journal of Cardiovascular MagneticResonance 2014, 16(Suppl 1):O100http://www.jcmr-online.com/content/16/S1/O100
© 2014 Mikolich et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the CreativeCommons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, andreproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Authors’ details1NEOMED, Hermitage, Pennsylvania, USA. 2Sharon Regional Health System,Sharon, Pennsylvania, USA.
Published: 16 January 2014
doi:10.1186/1532-429X-16-S1-O100Cite this article as: Mikolich et al.: Is cardiac MRI stress imaging a cost-saving strategy for obese patients? Journal of Cardiovascular MagneticResonance 2014 16(Suppl 1):O100.
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