Two-tiered approach to MRI for headache: a cost-effective way to use an expensive technology

The purpose of this study was to compare the diagnostic efficacy and cost implications of a proposed two-tiered approach to MRI in patients with headache. We identified 245 consecutive patients with headache using MRI studies performed at a tertiary care facility between October 2009 and July 2011. Three radiologists prospectively used FLAIR sequences from these MR studies to diagnose underlying abnormality or to identify the need for a comprehensive MRI study. We compared the diagnostic efficacy and the cost implications of such a two-tiered approach with those of conventional MRI from the perspectives of the payer, the patient, and the imaging facility. The sensitivity and specificity for two-tiered (83.3% and 100%, respectively) and conventional (91% and 97.8%, respectively) MRI approaches were not significantly different. Assuming a 50% reduction in the payment for the initial limited MRI performed as a first step of the two-tiered approach, this approach would have resulted in 44.8% savings to the payer. A substantial reduction in the scanner utilization time from 4168 minutes to 1249 minutes for the two-tiered approach would have enabled increased throughput at the imaging facility. Although 27 (11%) patients would have been recalled for a comprehensive MRI study in the two-tiered approach, the average time spent in the scanner by each patient would have been less for the two-tiered approach (5.1 minutes vs 17.0 minutes). A two-tiered approach to MRI can serve as a viable cost-effective alternative to the conventional approach.