High-Cost Neuropathy Screening

Are you paying too much for neuropathy screening?

Researchers at the University of Michigan found that less expensive, more effective tests are less likely to be used than the costlier ones.

Almost one-quarter of patients receiving neuropathy diagnoses undergo high-cost, low-yield MRIs while very few receive low-cost, high-yield glucose tolerance tests, according to the study that will be published Jan. 23 in the Archives of Internal Medicine.

“Patients diagnosed with peripheral neuropathy typically are given many tests but physicians are highly variable in their approach. Neurologists spend a lot of money to work up a diagnosis of neuropathy. The question is whether that money is well spent,” lead researcher Callaghan says.

For patients with peripheral neuropathy, the nerves that carry information to and from the brain don’t work property. This commonly leads to tingling or burning in arms or legs and loss of feeling — and the symptoms can go from subtle to severe.

Diabetes is the most common cause of this type of nerve problem. Peripheral neuropathy is found in about 15 percent of those over age 40.

Researchers used the 1996-2007 Health and Retirement Study to identify individuals with a diagnosis of peripheral neuropathy, focusing  on 15 relevant tests and examined the number and patterns of tests six months before and after the initial diagnosis.

“Our findings, that MRIs were frequently ordered by physicians, but a lower-cost glucose tolerance test was rarely ordered, show that there is substantial opportunity to improve efficiency in the evaluation of peripheral neuropathy,” Callaghan says.

“Currently no standard approach to the evaluation of peripheral neuropathy exists. Many tests cost a lot of money, but there is common agreement on evaluations.”

“The climbing rates of diabetes in the U.S. make this research even more important,” says co-author Kenneth M. Langa, M.D., Ph.D., a professor of Internal Medicine at U-M.

“We know more and more people may develop peripheral neuropathy because it is commonly caused by diabetes. Our study suggests that the work-up currently used for neuropathy isn’t standardized and tests that are less useful and more expensive may be used too often,” says Langa. “We need a more efficient way to handle this increasingly common diagnosis.”

Journal reference: Arch Intern Med. 2012; 172[2]:127-132.