Economic consequences of diagnostic imaging for vocal cord paralysis

Rationale and Objectives. The purpose of this retrospective study was to es timate the economic consequences of evaluating suspected vocal cord paralys is with magnetic resonance (MR) imaging and computed tomography (CT). Materials and Methods. Reports from MR imaging (n = 30) or CT (n = 19) stud ies of the neck in 49 patients were retrospectively reviewed for causes of vocal cord paralysis. The patients were divided into high-suspicion (n = 20 ) and low-suspicion (n = 29) groups, based on the presence or absence of a clinically detectable abnormality other than vocal cord immobility. Clinic and inpatient charts were examined to determine the work-up in all cases. T he Medicare Resource-based Relative Value Scale was used to estimate the co sts of most procedures. Results, The high-clinical-suspicion group included nine true-positive, fou r false-positive, seven true-negative, and no false-negative cases. Further work-up was performed in seven true-positive, three false-positive, and on e true-negative cases. The total cost of immediate diagnostic work-up in th ese 20 patients, including MR imaging and/or CT, was $20,737 ($2,304 per tr ue-positive case). The low-suspicion group included two true-positive, nine false-positive. 18 true-negative, and no false-negative cases. Further wor k-up was performed in both true-positive, four false-positive, and two true -negative cases. The total cost of immediate diagnostic work-up in these 29 patients was $21,698, (mean, $748; $10,849 per true-positive case). Conclusion. The average cost of finding space-occupying lesions in patients with vocal cord paralysis is more than 4.5 times higher in patients withou t suspicious antecedent clinical findings than in those with such a history . The benefits of obtaining negative findings and of detecting a small numb er of space-occupying lesions should be weighed against the costs of such e xaminations and of additional work-up for false-positive findings.