In an accompanying JNCI editorial, Robin Wabroff and Joan Warren of the NCI's Health Services and Economics Branch, wrote that "the use of high-cost imaging found in the Greenberg study may seem excessive, and intensive care at the end of life is expensive to the Medicare program, the healthcare system overall and for patients and their families."
However, they continued, the survival trajectory for stage IV patients is variable, and conducting such tests may "inform decisions about continuing or changing treatment, symptom management or hospice referral."
The JNCI researchers' conclusions, however, are attenuated by a more recent report in the journal Health Affairs, which found that growth in the use of advanced imaging tests in the Medicare population has slowed in recent years. In part, the reasons are that there are fewer radiologists, and payments from federal and other payers have been reduced.
These reports are further confounded by a report in the June 13 Journal of the American Medical Associationby researchers at the University of California San Francisco, that found that between 1996 and 2010, use of advanced imaging by providers in integrated healthcare systems, who are bound in large part by bundled payments, has increased significantly.
"Given the high costs of imaging—estimated at $100 billion annually—and other harms, these benefits should be quantified and evidence-based guidelines for using imaging should be developed that clearly balance benefits against financial costs and health risk," they wrote.
Meanwhile, Medicare has targeted expensive imaging for further cost cuts, and is seeking to inform consumers and others about potentially unnecessary MRI, CT, and mammography imaging and the wide variation in their use.