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. 2012 Jan 23;172(2):127-32.
doi: 10.1001/archinternmed.2011.1032.

Tests and expenditures in the initial evaluation of peripheral neuropathy

Brian Callaghan  1 , Ryan McCammon, Kevin Kerber, Xiao Xu, Kenneth M Langa, Eva Feldman
Affiliations

Tests and expenditures in the initial evaluation of peripheral neuropathy

Brian Callaghan et al. Arch Intern Med. .

Abstract

Background: Peripheral neuropathy is a common disorder in which an extensive evaluation is often unrevealing.

Methods: We sought to define diagnostic practice patterns as an early step in identifying opportunities to improve efficiency of care. The 1996-2007 Health and Retirement Study Medicare claims-linked database was used to identify individuals with an incident diagnosis of peripheral neuropathy using International Classification of Diseases, Ninth Revision, codes and required no previous neuropathy diagnosis during the preceding 30 months. Focusing on 15 relevant tests, we examined the number and patterns of tests and specific test utilization 6 months before and after the incident neuropathy diagnosis. Medicare expenditures were assessed during the baseline, diagnostic, and follow-up periods.

Results: Of the 12, 673 patients, 1031 (8.1%) received a new International Classification of Diseases, Ninth Revision, diagnosis of neuropathy and met the study inclusion criteria. Of the 15 tests considered, a median of 4 (interquartile range, 2-5) tests were performed, with more than 400 patterns of testing. Magnetic resonance imaging of the brain or spine was ordered in 23.2% of patients, whereas a glucose tolerance test was rarely obtained (1.0%). Mean Medicare expenditures were significantly higher in the diagnostic period than in the baseline period ($14,362 vs $8067, P < .001).

Conclusions: Patients diagnosed as having peripheral neuropathy typically undergo many tests, but testing patterns are highly variable. Almost one-quarter of patients receiving neuropathy diagnoses undergo high-cost, low-yield magnetic resonance imaging, whereas few receive low-cost, high-yield glucose tolerance tests. Expenditures increase substantially in the diagnostic period. More research is needed to define effective and efficient strategies for the diagnostic evaluation of peripheral neuropathy.

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Conflict of interest statement

Conflicts of Interest:

Funding/support: Drs. Callaghan and Feldman are supported by a NIH T32 grant, the Katherine Rayner Program, and by the Taubman Medical Institute. The Health and Retirement Study is supported by the National Institute on Aging (U01 AG09740), and performed at the Institute for Social Research, University of Michigan. Dr. Langa is supported by National Institute on Aging grant R01 AG030155. Dr. Kerber is supported by NIH/NCRR #K23 RR024009 and AHRQ #R18 HS017690. Dr. Kerber also received speaker honoraria from the American Academy of Neurology 2010 and 2011 annual meeting, and performed consulting work for the American Academy of Neurology.

Figures

Figure 1
Figure 1
Utilization of diabetic and AAN recommended tests in neuropathy patients HA1C=hemoglobin A1C, GTT=glucose tolerance test, SPEP=serum protein electrophoresis
Figure 2
Figure 2
EMG and MRI utilization in neuropathy patients EMG=Electromyography
Figure 3
Figure 3
Utilization of common diagnostic tests in neuropathy patients ANA=antinuclear antibody, ESR=erythrocyte sedimentation rate, TSH=thyroid stimulating hormone, CBC=complete blood count, CMP=comprehensive metabolic panel, PT=protime. PTT=partial thromboplastin time
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