Economic Impact of Diagnostic Imaging in the Workup of Uncomplicated Bell's Palsy

Abstract

Objective Our primary objective is to identify the costs associated with imaging in the diagnostic workup of uncomplicated Bell's palsy. Our secondary objective is to identify a dollar amount spent on extraneous diagnostic testing on a state and national level.

Design and Setting Retrospective chart analysis was performed at our tertiary care medical center between 2007 and 2018. International Statistical Classification of Diseases-10 code G51.0 was used to identify patients with Bell's palsy seen by the senior author. A total of 163 patients were divided into two groups: those having received imaging and those diagnosed without imaging. The imaging group was then further subdivided by imaging modality: computed tomography (CT) only, magnetic resonance imaging (MRI) only, or both. There was a total of 138 scans in 115 patients. To quantify the amount spent by insurance companies or patients on these scans, net expected pay (NEP) for each modality was used as a representation of cost. The NEP for a CT was $618. The NEP for an MRI was $1,119. The NEP for both scans was $1,737. We extrapolated our results to a state and national level.

Main Outcome Measurements Cost of workup; state and national economic burden.

Results Extrapolating our data, we forecast that in Illinois and in the United States, over $2 million and $53 million, respectively, are spent on unnecessary imaging.

Conclusion By highlighting an unnecessary financial burden, our study provides concrete evidence to support the American Academy of Otolaryngology's recommendation that clinicians should not perform routine imaging studies when diagnosing uncomplicated Bell's palsy.

Keywords

Bell's palsy - facial paralysis - emergency medicine - computerized tomography - magnetic resonance imaging - cost data - neurology - urgent care - otolaryngology

Publikationsverlauf

Eingereicht: 15. Mai 2020

Angenommen: 12. Oktober 2020

Artikel online veröffentlicht:
21. Januar 2021

• References

• 1 Peitersen E. Bell's palsy: the spontaneous course of 2,500 peripheral facial nerve palsies of different etiologies. Acta Otolaryngol Suppl 2002; 122 (549) 4-30
• 2 Peitersen E. The natural history of Bell's palsy. Am J Otol 1982; 4 (02) 107-111
• 3 Adour KK, Bell DN, Hilsinger Jr RL. Herpes simplex virus in idiopathic facial paralysis (Bell palsy). JAMA 1975; 233 (06) 527-530
• 4 Baugh RF, Basura GJ, Ishii LE. et al. Clinical practice guideline: Bell's Palsy executive summary. Otolaryngol Head Neck Surg 2013; 149 (05) 656-663
• 5 House JW, Brackmann DE. Facial nerve grading system. Otolaryngol Head Neck Surg 1985; 93 (02) 146-147
• 6 De Seta D, Mancini P, Minni A. et al. Bell's palsy: symptoms preceding and accompanying the facial paresis. ScientificWorldJournal 2014; 2014: 801971
• 7 Salinas RA, Alvarez G, Daly F, Ferreira J. Corticosteroids for Bell's palsy (idiopathic facial paralysis), In: The Cochrane Collaboration. ed. Cochrane Database of Systematic Reviews. Chichester, UK: John Wiley & Sons, Ltd; 2010. CD001942.pub4
• 8 Hauser WA, Karnes WE, Annis J, Kurland LT. Incidence and prognosis of Bell's palsy in the population of Rochester, Minnesota. Mayo Clin Proc 1971; 46 (04) 258-264
• 9 Fahimi J, Navi BB, Kamel H. Potential misdiagnoses of Bell's palsy in the emergency department. Ann Emerg Med 2014; 63 (04) 428-434
• 10 Veillona F, Ramos-Taboada L, Abu-Eid M, Charpiot A, Riehm S. Imaging of the facial nerve. Eur J Radiol 2010; 74 (02) 341-348
• 11 Burmeister HP, Baltzer PAT, Volk GF. et al. Evaluation of the early phase of Bell's palsy using 3 T MRI. Eur Arch Otorhinolaryngol 2011; 268 (10) 1493-1500
• 12 Sartoretti-Schefer S, Brändle P, Wichmann W, Valavanis A. Intensity of MR contrast enhancement does not correspond to clinical and electroneurographic findings in acute inflammatory facial nerve palsy. AJNR Am J Neuroradiol 1996; 17 (07) 1229-1236
• 13 Holland J, Bernstein J. Bell's palsy. BMJ Clin Evid. 2011: 2011
• 14 Agarwal R, Manandhar L, Saluja P, Grandhi B. Pontine stroke presenting as isolated facial nerve palsy mimicking Bell's palsy: a case report. J Med Case Reports 2011; 5: 287
• 15 Phan NT, Panizza B, Wallwork B. A general practice approach to Bell's palsy. Aust Fam Physician 2016; 45 (11) 794-797
• 16 Fuller G, Morgan C. Bell's palsy syndrome: mimics and chameleons. Pract Neurol 2016; 16 (06) 439-444
• 17 Mower S. Bell's palsy: excluding serious illness in urgent and emergency care settings. Emerg Nurse 2017; 25 (01) 32-39
• 18 Adour KK. Otological complications of herpes zoster. Ann Neurol 1994; 35 (Suppl): S62-S64
• 19 Sweeney CJ, Gilden DH. Ramsay Hunt syndrome. J Neurol Neurosurg Psychiatry 2001; 71 (02) 149-154
• 20 de Almeida JR, Guyatt GH, Sud S. et al; Bell Palsy Working Group, Canadian Society of Otolaryngology - Head and Neck Surgery and Canadian Neurological Sciences Federation. Management of Bell palsy: clinical practice guideline. CMAJ 2014; 186 (12) 917-922
• 21 Katusic SK, Beard CM, Wiederholt WC, Bergstralh EJ, Kurland LT. Incidence, clinical features, and prognosis in Bell's palsy, Rochester, Minnesota, 1968-1982. Ann Neurol 1986; 20 (05) 622-627