Financial Implications of Revised ACR Guidelines for Estimated Glomerular Filtration Rate Testing Before...

Area of Science:

• Radiology and Medical Imaging
• Health Economics
• Clinical Practice Guidelines

Background:

• Renal function screening is often performed before contrast-enhanced MRI.
• Recent guideline changes by the American College of Radiology (ACR) may alter screening requirements for gadolinium-based contrast agents.
• Quantifying the financial impact of these guideline changes is crucial for healthcare providers.

Purpose of the Study:

• To determine the financial implications of removing the requirement for renal function screening prior to contrast-enhanced MRI.
• To analyze the cost-effectiveness of current screening practices versus a no-screening approach.

Main Methods:

• Retrospective analysis of 41,336 MRI examinations over 12 months at a quaternary care center.
• Assessment of examination volume, labor costs, and material costs using a base case model.
• Univariate, bivariate, and multivariate sensitivity analyses were performed, incorporating Medicare reimbursement data.

Main Results:

• The annual base case cost for point-of-care estimated glomerular filtration rate (eGFR) testing was $126,058, with a net departmental cost of $78,330 even with 100% Medicare reimbursement.
• MRI technologist time and i-Stat cartridge costs were identified as major cost drivers.
• Estimated costs ranged from $6,845 to $787,257 in multivariate analyses.

Conclusions:

• Changes in ACR screening guidelines for contrast agents have significant financial consequences.
• Eliminating routine renal function screening before contrast-enhanced MRI presents potential cost savings for healthcare institutions.