Rates, costs and determinants of lumbar spine imaging in population-based women born in 1973-1978: Data from the Australian Longitudinal Study on Women's Health

PLoS One. 2020 Dec 3;15(12):e0243282. doi: 10.1371/journal.pone.0243282. eCollection 2020.

Abstract

Objective: There are concerns that lumbar spine imaging represents low value care. Our aim was to examine the use of lumbar spine imaging [radiography, computed tomography (CT), magnetic resonance imaging (MRI)] over 20 years, and costs and person-level characteristics of imaging in a large cohort of Australian women.

Methods: The Australian Longitudinal Study on Women's Health (ALSWH) is a longitudinal population-based survey of women randomly selected from national health insurance scheme (Medicare) database. This study examined 13458 women born in 1973-1978 who consented to link their ALSWH and Medical Benefits Scheme records. Self-reported data on demographics, body mass index, depression, physical and mental health, and back pain were collected in each survey performed in 1996, 2000, 2003, 2006, 2009, 2012, and 2015. Data on lumbar spine imaging from 1996 to 2015 were obtained from the Medical Benefits Scheme database.

Results: 38.9% of women underwent some form of lumbar spine imaging over 20 years. While radiography increased from 1996 to 2011 and decreased thereafter, CT and MRI continued to increase from 1996 to 2015. In women with self-reported back pain, depression and poorer physical health were associated with imaging, with no significant differences in types of imaging. Based on imaging rates in ALSWH, the estimated costs for Australian women aged 30-39 years were AU$51,735,649 over 2011-2015.

Conclusions: Lumbar spine imaging was common in population-based Australian women, with rates increasing over 20 years. Depression and poor physical health were associated with lumbar spine imaging. Raising awareness of this in clinicians is likely to result in significant cost savings if clinical guidelines are followed, with the potential of freeing resources for high value care and health outcomes.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Australia / epidemiology
  • Back Pain / psychology
  • Costs and Cost Analysis
  • Female
  • Humans
  • Longitudinal Studies
  • Lumbar Vertebrae / diagnostic imaging
  • Lumbosacral Region / diagnostic imaging*
  • Magnetic Resonance Imaging / economics*
  • Magnetic Resonance Imaging / statistics & numerical data
  • Magnetic Resonance Imaging / trends
  • Middle Aged
  • National Health Programs
  • Radiography
  • Women's Health

Grants and funding

The Australian Longitudinal Study on Women’s Health is funded by the Australian Government Department of Health and Ageing (https://www.health.gov.au/) (GDM). The current linkage study is further supported by the Alfred Foundation (https://www.alfredhealth.org.au/the-alfred-foundation) (FMC, SMH) and Medical Research Future Fund (https://www.health.gov.au/initiatives-and-programs/medical-research-future-fund) (DMU, FMC, HT, GDM). YW and AEW are the recipients of National Health and Medical Research Council (NHMRC, https://www.nhmrc.gov.au/) Translating Research into Practice Fellowship (APP1168185 and APP1150102, respectively). SMH is the recipient of NHMRC Early Career Fellowship (APP1142198). YZL is the recipient of NHMRC Clinical Postgraduate Scholarship (APP1133903), Royal Australasian College of Physicians Woolcock Scholarship, Australian Rheumatology Association Top-Up Scholarship and Monash University Postgraduate Excellence Award. DMU is the recipient of NHMRC Career Development Fellowship (Clinical Level 2, APP1142809). GDM is the recipient of NHMRC Principal Research Fellowship (APP1121844). HT is the recipient of NHMRC Practitioner Fellowship (APP1942516). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.