E2086. Imaging Utilization and Cost of Drug Use in an Urban Academic Medical Center During the Contemporary Opioid Epidemic
Albert Einstein College of Medicine; Lincoln Medical Center
Albert Einstein College of Medicine; Staten Island University Hospital
Montefiore Medical Center
Linda Haramati ;
Montefiore Medical Center
The purpose of this study is to explore the rate and cost of imaging utilization for patients with a drug abuse diagnosis vs those without a drug abuse diagnosis.
Materials and Methods:
This is a retrospective study from an inner city urban multi-site academic medical center. IRB approval was obtained with a waiver of informed consent. A drug cohort comprised all patients 12 years and older presenting to the Emergency Department (ED) January 2017-June 2019 with a positive urine toxicology and an ICD code associated with drug use or abuse. The comparison cohort was randomly selected from a group of >302 000 ED patients who presented with no or negative urine toxicology and no documented drug use/abuse ICD code. Data extracted from the EMR included demographics, number and type of imaging studies, Charlson comorbidity index, and in-hospital mortality during the study period. The cohorts were compared using the Student t-test and Chi-square as appropriate.
The drug cohort comprised 3191 patients and the comparison cohort 3200 patients. The drug cohort was older, mean age 45.67, ±14.88 vs 43.91 ±20.57 years, more often male, 2026 (63%) vs.1255 (39%), and had a higher mean Charlson score 3.33 vs 1.78, p<0.0001 all, than the comparison cohort, respectively. The drug cohort also had a higher in-hospital mortality rate, 135 (4.23%) vs 70 (2.19%), p<0.0001. The majority of both cohorts were ethnic minorities (<10% white). The drug cohort had significantly more imaging vs the comparison group, total 36,413 (mean 11.41 exams/patient) vs total 12,399 (mean 3.87 exams/patient), p <0.0001. This was true, per patient, respectively for all modalities; radiography 5.76 vs 1.67, CT 2.29 vs 0.59, MRI 0.63 vs 0.24, ultrasound 1.63 vs. 0.85, echocardiography 0.78 vs. 0.22, nuclear medicine 0.223 vs. 0.096 and fluoroscopy 0.036 vs. 0.020, p <0.05 for all, except for female
mammography, 0.14 vs. 0.31, p<0.0001. Total imaging costs were nearly 300% higher for the drug vs comparison cohort, $4,172,081 vs. $1,414,910, p <0.0001.
Imaging utilization and costs were substantially higher for patients who use drugs compared with the broader ED population in an underserved urban population. The excess costs of increased imaging utilization represent an underappreciated burden of the current opioid epidemic.