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Do More Imaging Tests Improve Cancer Outcomes?

http://blogs.wsj.com/health/2010/04/27/do-more-imaging-tests-improve-cancer-outcomes/

By Katherine Hobson



The cost of scans such as CT, MRI and PET for cancer patients is rising faster than the total cost of those people’s medical care, a study published in JAMA finds. What’s harder to figure out is whether the money being spent is helping people live longer.

The JAMA study, by Duke University researchers, tracked the increase in costs between 1999 and 2006 among Medicare beneficiaries with six types of cancer. “Significant” annual increases in imaging use occurred among all the cancers, with lung cancer and lymphoma patients incurring more than $3,000 in imaging costs within two years of diagnosis.

The authors write that it’s not possible to tell “whether the rapid increase in the use of advanced imaging is a result of the novelty of the technologies, better outcomes or a shift to new revenue sources” for doctors, some of whom own their own imaging equipment.

But a National Bureau of Economic Research working paper from earlier this month finds for that middle option. The paper, “Has Medical Innovation Reduced Cancer Mortality?” estimates that 40% of the drop in cancer mortality between 1996 and 2006 is attributable to the lagging effects of imaging innovation. By contrast, the paper attributed only 25% of the drop to drug innovation.

“The types of cancer where there was the largest expansion in the use of advanced imaging saw larger drops in mortality,” says author Frank Lichtenberg, a professor at Columbia Business School. He tells the Health Blog he controlled for factors like the number of people being diagnosed with a particular cancer, what kind of chemo they used, and the overall downward trend in cancer mortality.

It’s an observational study, however, and so can only show that imaging use and mortality are correlated. It’s interesting, but like any such study, “I wouldn’t view it as a definitive answer,” says Laurence Baker, a professor and chief of Health Services Research at Stanford University, who has studied the challenges of measuring value in imaging.

Prospective trials represent the best way to pin down whether outcomes are better when advanced imaging tests are used, Baker tells the Health Blog. “These things are useful and we want to have them around,” he says. “No one wants to live in a world without MRI or PET scans.” At the same time, though, he says it’s pretty clear that imaging is overused in some cases. “We’ve had a harder time figuring out when to use them and when not to.”

Photo: Associated Press