Institute for Community Medicine - Department SHIP/KEF, University Medicine Greifswald, Greifswald, MV, Germany
Institute for Community Medicine - Department of Family Medicine, University Medicine Greifswald, Greifswald, MV, Germany.
BMJ Open. 2022 Jan 7;12(1):e056572. doi: 10.1136/bmjopen-2021-056572.
Whole-body MRI (wb-MRI) is increasingly used in research and screening but little is known about the effects of incidental findings (IFs) on health service utilisation and costs. Such effects are particularly critical in an observational study. Our principal research question was therefore how participation in a wb-MRI examination with its resemblance to a population-based health screening is associated with outpatient service costs.
Prospective cohort study.
General population Mecklenburg-Vorpommern, Germany.
Analyses included 5019 participants of the Study of Health in Pomerania with statutory health insurance data. 2969 took part in a wb-MRI examination in addition to a clinical examination programme that was administered to all participants. MRI non-participants served as a quasi-experimental control group with propensity score weighting to account for baseline differences.
Outpatient costs (total healthcare usage, primary care, specialist care, laboratory tests, imaging) during 24 months after the examination were retrieved from claims data. Two-part models were used to compute treatment effects.
In total, 1366 potentially relevant IFs were disclosed to 948 MRI participants (32% of all participants); most concerned masses and lesions (769 participants, 81%). Costs for outpatient care during the 2-year observation period amounted to an average of €2547 (95% CI 2424 to 2671) for MRI non-participants and to €2839 (95% CI 2741 to 2936) for MRI participants, indicating an increase of €295 (95% CI 134 to 456) per participant which corresponds to 11.6% (95% CI 5.2% to 17.9%). The cost increase was sustained rather than being a short-term spike. Imaging and specialist care related costs were the main contributors to the increase in costs.
Communicated findings from population-based wb-MRI substantially impacted health service utilisation and costs. This introduced bias into the natural course of healthcare utilisation and should be taken care for in any longitudinal analyses.
全身磁共振成像（wb-MRI）在研究和筛查中应用日益广泛，但人们对偶然发现（IFs）对卫生服务利用和成本的影响知之甚少。在观察性研究中，这种影响尤为关键。因此，我们的主要研究问题是，参加类似于基于人群的健康筛查的 wb-MRI 检查如何与门诊服务成本相关。
前瞻性队列研究。
德国梅克伦堡-前波美拉尼亚州的一般人群。
分析包括参加波美拉尼亚健康研究并具有法定健康保险数据的 5019 名参与者。2969 人除了参加所有参与者都接受的临床检查计划外，还参加了 wb-MRI 检查。磁共振成像非参与者作为准实验对照组，通过倾向评分加权来考虑基线差异。
从索赔数据中检索到检查后 24 个月内的门诊费用（总医疗保健使用、初级保健、专科保健、实验室检查、影像学）。使用两部分模型计算治疗效果。
总共向 948 名磁共振成像参与者（所有参与者的 32%）披露了 1366 个潜在相关的 IFs；最常见的是肿块和病变（769 名参与者，81%）。在 2 年观察期内，磁共振成像非参与者的门诊护理费用平均为 2547 欧元（95%CI 2424 至 2671），磁共振成像参与者的费用为 2839 欧元（95%CI 2741 至 2936），表明每个参与者增加 295 欧元（95%CI 134 至 456），相当于增加 11.6%（95%CI 5.2%至 17.9%）。这种成本增加是持续的，而不是短期的激增。影像学和专科护理相关费用是增加成本的主要原因。
从基于人群的 wb-MRI 中获得的报告结果对卫生服务的利用和成本有重大影响。这给医疗保健利用的自然过程带来了偏差，在任何纵向分析中都应加以注意。
