Cost of Low-Value Imaging Worldwide: A Systematic Review

• Published in: Applied health economics and health policy 2024-07, Vol.22 (4), p.485-501
• Main Authors: Kjelle, Elin, Brandsæter, Ingrid Øfsti, Andersen, Eivind Richter, Hofmann, Bjørn Morten
• Format: Article
• Language: English
• Subjects: Clinical trials; Cohort analysis; Content analysis; Cost analysis; Cost assessments; Cost reduction; Cost-Benefit Analysis; Costs; Cross-sectional studies; Design; Diagnostic Imaging - economics; Global Health - economics; Health Administration; Health Care Costs - statistics & numerical data; Health care expenditures; Health Economics; Health services; Humans; Libraries; Medical imaging; Medicine; Medicine & Public Health; Opportunity costs; Patients; Pharmacoeconomics and Health Outcomes; Public Health; Quality of care; Quality of Life Research; Radiography; Resource allocation; Systematic Review
• ISSN: 1175-5652; 1179-1896; 1179-1896
• DOI: 10.1007/s40258-024-00876-2

Background and Objective Imaging with low or no benefit for the patient undermines the quality of care and amounts to vast opportunity costs. More than 3.6 billion imaging examinations are performed annually, and about 20–50% of these are of low value. This study aimed to synthesize knowledge of the costs of low-value imaging worldwide. Methods This systematic review was based on the PRISMA statement. The database search was developed in Medline and further adapted to Embase-Ovid, Cochrane Library, and Scopus. Primary empirical studies assessing the costs of low-value diagnostic imaging were included if published between 2012 and March 2022. Studies designed as randomized controlled trials, non-randomized trials, cohort studies, cross-sectional studies, descriptive studies, cost analysis, cost-effectiveness analysis, and mixed-methods studies were eligible. The analysis was descriptive. Results Of 5,567 records identified, 106 were included. Most of the studies included were conducted in the USA ( n = 76), and a hospital or medical center was the most common setting ( n = 82). Thirty-eight of the included studies calculated the costs of multiple imaging modalities; in studies with only one imaging modality included, conventional radiography was the most common ( n = 32). Aggregated costs for low-value examinations amounts to billions of dollars per year globally. Initiatives to reduce low-value imaging may reduce costs by up to 95% without harming patients. Conclusions This study is the first systematic review of the cost of low-value imaging worldwide, documenting a high potential for cost reduction. Given the universal challenges with resource allocation, the large amount used for low-value imaging represents a vast opportunity cost and offers great potential to improve the quality and efficiency of care.