Costs of incidental pancreatic cysts rise when physician, radiologist not on same page

When ordering physicians overmanage an incidental pancreatic cyst detected at MRI, it can lead to higher downstream costs, according to a new study published in the American Journal of Roentgenology. What can radiologists do to improve adherence to their recommendations?

“The follow-up management of incidental pancreatic cysts can entail considerable testing, including serial CT and MRI examinations and endoscopic ultrasound–guided fine-needle aspiration, along with office visits to discuss test results and subsequent evaluation and intervention,” wrote Andrew B. Rosenkrantz, MD, MPA, of the Department of Radiology at NYU Langone Medical Center in New York, and colleagues. “The costs associated with such events are important to consider given the increasing and unsustainable expenditures of the U.S. health care system, the wide variability of care delivery, and the increasing federal mandate to focus on value in health care delivery to improve the nation's health care system.”

The authors examined data from 200 patients with an incidental pancreatic cyst detected at MRI. They then analyzed downstream events and estimated downstream costs. Overall, estimated downstream costs averaged $460 per cyst. If there was any follow-up testing, the average was $872 per cyst. Nine patients had a clinically relevant outcome; the average downstream costs in those cases was $1,364.

When ordering physicians overmanaged relative to the radiologist’s recommendation, the average cost jumped to $842 per cyst. The average cost when they followed that recommendation or undermanaged was $631 and $252, respectively. The authors also found that the average cost when ordering physicians overmanaged relative to recommendations made by the American College of Radiology (ACR) incidental findings committee was $845, higher than when they were adherent to those recommendations ($811) or undermanaged ($252).

Rosenkrantz and colleagues also noted that whether or not radiologists recommended follow-up testing or followed the ACR incidental findings committee recommendations did not lead to a significant change in costs.

“These observations, combined with the low rate of ordering physician adherence to radiologists' recommendations, indicate the need for collaborative partnerships and other initiatives to foster greater adherence to radiologists' recommendations,” the authors wrote. “For example, radiology groups could adopt critical test results notification systems, automated reminders within electronic health systems, and other informatics solutions, to ensure that referrers are more fully aware of advised follow-up testing. In addition, radiologists could incorporate stronger language into their reports when no follow-up testing is recommended, as well as conduct targeted education of the relevant ordering physician groups regarding appropriate utilization and optimal imaging strategies for pancreatic cysts.”