High cost of yearly MRIs--so why not operate early and fix it for good?

[HopefulHeart]

This question may sound strange considering that OHS is not something to rush into if you don't have to. My experience has caused me to ask this question. I have a BAV that is in good shape and an aneurysm on the ascending aorta that is at 4.2 cm and stable. It hasn't grown since I first discovered it in 2006. I have no symptoms. My Cardio has taken the "watchful waiting" approach where I have an MRI every year. The Echos do not give accurate information on my aneurysm, so MRI has been determined to be best. However, here in NC, that MRI costs me $2000 every year out of pocket. And that's after insurance. My Cardio has said there is no way he could recommend surgery to repair everything now since he does not deem it medically necessary. But at the same time I have to ask, why not? My aorta has an aneurysm that will not get smaller, only bigger and my BAV will eventually fail. If I just had everything fixed now, I'd save the yearly $2000 on the MRI. What do you all think? Has the high cost of yearly scans forced any of you to ponder this question?

 

[Midpack]

OHS is a MAJOR surgery. Results are usually very good, but there are lot of eventual complications. Some minor and some serious (including death, of course). Not a walk in the park at all. It is my understanding that cardiologists and surgeons suggest it only if ABSOLUTELY necessary. I know that being in the waiting room causes lot of anxiety. But dont let it precipitate something as serious as an OHS.

Regards

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[Superman]

I guess I would first question the necessity of that level of testing. I've never had an MRI. I had yearly echos, which included a measurement of the aortic root. Once it was beyond a certain point, a CT scan was ordered. That verified the measurement and surgery was done. Since then, I've had two more CT scans in the four years since, but going foward it should be just echo's. I don't know which is more expensive between and MRI and a CT scan or why choose one over the other.

I wouldn't be so bold as to tell you to refuse the doctors orders, but I would consider a second opinion. $2,000 out of pocket is a big hole to start your healthcare year in. At 4.2cm, I think you'd be hard pressed to find a surgeon that would operate. However, you my find a cardiologist or surgeon that is comfortable with a yearly echo and skipping the MRI, if you are.

 

[HopefulHeart]

Hi Superman.......thanks for your response. I just had a situation where I had an echo on Nov. 19th. The Cardio got the scan and said it showed my aneurysm had grown to 4.8cm in one years time. He ordered an MRI to confirm the measurement. MRI was done last week, it showed the aneurysm had not grown and was in fact still at 4.2cm. I don't know how an echo could be so wrong, but I don't want to go through a scare like that again and feel that I can't trust an echo going forward. My Cardio says I should stick with the echo, but again I feel like I can't trust it. So the yearly MRI plan was devised.

 

[Bryan B]

This question may sound strange considering that OHS is not something to rush into if you don't have to. My experience has caused me to ask this question. I have a BAV that is in good shape and an aneurysm on the ascending aorta that is at 4.2 cm and stable. It hasn't grown since I first discovered it in 2006. I have no symptoms. My Cardio has taken the "watchful waiting" approach where I have an MRI every year. The Echos do not give accurate information on my aneurysm, so MRI has been determined to be best. However, here in NC, that MRI costs me $2000 every year out of pocket. And that's after insurance. My Cardio has said there is no way he could recommend surgery to repair everything now since he does not deem it medically necessary. But at the same time I have to ask, why not? My aorta has an aneurysm that will not get smaller, only bigger and my BAV will eventually fail. If I just had everything fixed now, I'd save the yearly $2000 on the MRI. What do you all think? Has the high cost of yearly scans forced any of you to ponder this question?

Before I had my surgery to replace my aortic root and ascending aorta I was being watched for 2-3 years. The most accurate way to get a precise measurement on an aneurysm is with a CT scan, followed closely by a cardiac MRI. I had a CT scan about 1 month before surgery and my aortic root was measured at 5.4 and my ascending aorta was measured at 5.8. Three months earlier the measurements by MRI were 5.2 and 5.4. When he did the surgery the exact measurements were 5.5 and 6.0. When my cardio was measuring my aortic root before it reached the stage he suggested MRI scans, my aortic root size was all over the place depending on who the echo tech was. They just couldn't get an accurate reading like an MRI or especially a CT scan.

My surgeon is one of the few who sees his patients for life. I saw him annually the first two years and now we are going to every 18 months. I see my cardio every 18 months to get an echo on my tissue valve, so I see one of them or the other every 9 months. My surgeon did a MRI at my first annual visit and a CT scan at the second annual visit. The reason he alternates them is to limit the amount of radiation exposure from the CT scan. He told me before my surgery that a CT is the "gold standard" for measuring aortic aneurysms, but for routine checkups he prefers to alternate the MRI with the CT scan. If I remember correctly the CT scan is substantially less expensive than the MRI, and the test is much faster without the claustrophobia.

As long as your BAV valve is in good shape I seriously doubt that they would consider surgery for your aneurysm until it reaches the 5.0 mark. They wanted to do mine when I measured 5.2 / 5.4 but due to no health insurance I had to wait. After he did the CT scan that gave the 5.4 / 5.8 measurements he scheduled me for surgery (2 weeks later) and said he had to do the surgery now and worry about the insurance later. The week before the surgery the insurance came through for me.

I just happen to have my insurance statement from the CT Scan I had this past August for my regular checkup. Retail was around 3K and I paid 150.00. I think the MRI runs about 1K more. Looking even closer at the bill my insurance paid a fraction of that 3K. I paid 150.00, or 20% of the total cost my provider was charged. They paid 600.00, so that means that the CT scan retailed for 3K but they only charged my insurance provider 750.00 total.

 

[AZ Don]

My aorta has an aneurysm that will not get smaller, only bigger and my BAV will eventually fail. If I just had everything fixed now, I'd save the yearly $2000 on the MRI. What do you all think? Has the high cost of yearly scans forced any of you to ponder this question?

While it is not likely that your aneurysm will get smaller it is not inevitable that it will get larger either. I saw a recent post from someone taking Losartan stating that their aneurysm did actually decrease. Neither is it certain that your BAV will fail. The numbers are all over the place in the research but I think the average estimated failure rate is less than 50%. So the problem here is that you are still a ways away from the surgical criteria and so will have difficulty finding a Dr and especially an insurance company that would support having surgery.

Much more than the other tests the accuracy of the echo is dependent on operator skill. Perhaps you could talk to your Dr. about where you might get an accurate echo? It will probably cost less than the MRI. You could also discuss whether it needs to be checked every year. Perhaps you could go two years, or even 18 months between tests? I wasn't in the waiting room very long before having surgery for my aneurysm, though I am now in the waiting for my BAV and expect to have follow-up tests every year or two.

 

[clay_from_nj]

Hmmm...never had an MRI or a CT scan, except to check my neck after a car accident many years ago.

 

[HopefulHeart]

Much more than the other tests the accuracy of the echo is dependent on operator skill. Perhaps you could talk to your Dr. about where you might get an accurate echo?

That's a good point AZ Don. The more I think about what happened, the more I'm starting to wonder if the echo was not done correctly, giving the false measurement on my aneurysm, which in turn caused my Cardio to panic and order an MRI. Sadly, if this is indeed what happened then that means I paid for an MRI that I did not need to have and spent my Thanksgiving thinking I was on the brink of surgery.

 

[ottagal]

Hi HopefulHeart,

AZ Don has made an excellent point. I have had echos over the years and to be honest, never rely on 'one' echo report anymore as I have had variation in mine. I undertand TEEs (transesophogeal echos) are more accurate than TOEs. If you have had a few echos which are consistent over, then I feel more confident in the reading/trend.

Hang in there....

 

[epstns]

HopefulHeart - IF this ever happens again, why not ask your doc to order a second echo, at a different facility, to confirm/refute the findings of the first. There are, as you now know, so many variables in echo measurements that even the same tech may get different results on different days. If you were to go to a different echo tech, and the results were consistent with the past echo's, you could disregard the one echo as a statistical anomaly - an accidental finding that is not valid. If both echo's confirm similar results, you could use the results to plan your treatment in confidence.

 

[HopefulHeart]

Another good idea epstns. Thanks! That's definitely something to suggest to my doc if I'm put in the same position again. And 2 echos would probably still be cheaper than one MRI.

 

[Bryan B]

From what I have been able to find on the net, the retail price for 2 echos would cost about the same as one MRI. If your cardio does the echo in his office it might be less expensive than if you have it done at a hospital. Back when I was only getting echos my cardio told me that getting an accurate reading on the size of an aortic root is more difficult, but it can be done if the echo tech is experienced at doing it. I was getting readings anywhere from 3.6 to 4.2 with the readings going up and down at random. That is when they decided to send me to get a MRI for a more definitive answer. Like I said in my earlier post, the results from the MRI yielded significantly higher readings and proved to be more accurate than the echos I was getting.

 

[HopefulHeart]

Like I said in my earlier post, the results from the MRI yielded significantly higher readings and proved to be more accurate than the echos I was getting.

Now if only the MRI were the same price as the echo, I'd be happy.