Non-invasive brain imaging as a preventative measure

According to (Goldsteen, 2014, pg 142) cerebrovascular disease is within the 10 leading causes of death in the U.S. and the many causes of cerebrovascular disease including: stress, smoking, overweight, high blood pressure, increase amounts of alcohol, and not enough exercise (NHS Choices, 2015).  All of these factors can lead to the most common forms of cerebrovascular disease including: stroke, transient ischemic attack, subarachnoid hemorrhage, and vascular dementia (NHS Choices, 2015). Even though there is currently no cure after cerebrovascular disease occurs, there are current treatments and medications. Additionally, there are important preventive measures that should be considered a priority by healthcare professionals as possible interventions to: prevent, reduce symptoms or severity of disease. One intervention that can be used as a preventative measure, is improving the access to brain imaging. “American Brain,” n.d. lists the different types of brain imaging that are used as diagnostic tools, including: Computed Tomography (CT) scans, Magnetic Resonance Imaging (MRI)s, Functional Magnetic Resonance Imaging (fMRI), and many others. These brain imaging techniques are often used by medical professionals during the diagnosis and treatment process, after symptoms of disease have been noticed. Unfortunately, for cerebrovascular diseases, time can be crucial; research by Longstreth et al., (2002) found that MRI scans that were conducted 5 years after an initial normal MRI scan contained increased amounts of infarcts within the participants. To clarify, after 5 years a new MRI was compared to initial MRI scans which did not show abnormalities; this suggests that abnormalities can develop within 5 years and brain imaging such as an MRI scan can be used to detect any early characteristics that can lead to a severe disease. If medical professionals detect early signs, including infarcts, then treatment can be started immediately to prevent progress of disease. In another study, van der Kolk ( as cited in Gounis et al., 2015) has shown that a combination of MRI and Positron Emission Tomography (PET) can be used to detect inflammation near infarcted areas in the brain; inflammation is also a sign of cell and tissue damage in the central nervous system. Both inflammation and infarcts can be detected before tissue damage or brain injury develops as a result of disease.

Therefore, it is important that brain imaging resources are expanded and used as part of a patient's regular medical routine, because this preventative measure can detect abnormalities in the brain, spinal cord, and nerves as soon as they occur; this will prevent disease and it symptoms.  Improving the access to brain imaging will improve quality of life and will decrease costs in the long run if used on a regular basis (Oliveira, n.d.).

 

Comparing the costs

Preventative measures cost less in the long run compared to when disease has occurred; even if insurance does not cover brain imaging such as CT or MRI scans, the price that patients pay for them would still be less than the price that they would have to pay after cerebrovascular disease occurs. Lets consider the following healthcare costs whether the patient has insurance or not. For example, let's say that in a “perfect world” a patient gets a brain scan once a year and will cost between $50-$5000 annually (Cost of Stroke Treatment - Consumer Information, n.d.). In another scenario, after a brain scan, the doctor notices that a patient has a blood clot, and it needs to be treated immediately. The patient can take medication without being hospitalized; this will cost between $50-$5000 for the brain scan plus $2,200-$5,978 for medication (Cost of Stroke Treatment - Consumer Information, n.d.).

We can compare this with a worst case scenario in which a patient has a stroke because symptoms were not noticed on time. This patient will then need to be hospitalized for a few days; the costs are between $9,100-$19,500 because, they will need to take medications which can cost between $2,200-$5,978 and they will also need regular brain scans to determine: the effects on the brain, progression of disease, or to detect secondary injury; this will cost an additional $50-$5000 for each scan (Cost of Stroke Treatment - Consumer Information, n.d.). In this worst case scenario, the total costs for a patient after having a stroke are between $11,350-$30,478, and it does not include long term post-stroke costs that result from rehabilitation, regular check-ups, or loss of income due to disability (Cost of Stroke Treatment - Consumer Information, n.d.).

Healthcare costs per patient	Preventing stroke with scans estimated costs	Pre-stroke treatment Estimated costs	Post-stroke Estimated costs
Brain imaging	~$50-$5000	~$50-$5000	~$50-$5000
Medications		~$2,200-$5,978	~$2,200-$5,978
Hospitalization			~$9,100-19,500

According to Mozaffarian et al (as cited in Sandberg, 2016) the overall cost of strokes, a cerebrovascular disease, can increase from $71.6 billion to $184.1 billion dollars per year by 2030. Health care professionals need to find a way to reduce the overall costs by implementing more preventative care programs that include brain imaging. Finally, brain imaging is a non-invasive technique that can be used to determine disease in the brain and it should be cost effective to patients.

Citations

American Brain Tumor Association. Types of Brain Scans. (n.d.). Retrieved October 15, 2016, from http://www.abta.org/brain-tumor-information/diagnosis/types-of-brain-scans.html

Cost of Stroke Treatment - Consumer Information. (n.d.). Retrieved October 19, 2016, from http://health.costhelper.com/treating-stroke.cost.html

Goldsteen, R. L., DrPH. (20140717). Introduction to Public Health, Second Edition, 2nd Edition. [VitalSource Bookshelf Online]. Retrieved from https://bookshelf.vitalsource.com/#/books/9780826196675/

Goldstein, L. B., Higashida, R. T., Howard, V. J., Johnston, S., Khavjou, O. A., Lackland, D. T., . . . Trogdon, J. G. (2013, May 22). Costs to treat stroke in America may double by 2030. Retrieved October 19, 2016, from http://newsroom.heart.org/news/costs-to-treat-stroke-in-america-may-double-by-2030

Gounis, M. J., Van der Marel, K., Marosfoi, M., Mazzanti, M. L., Clarençon, F., Chueh, J., ... Bogdanov, A. A. (2015,September 08). Imaging Inflammation in Cerebrovascular Disease: Figure. Stroke, 46(10), 2991-2997. doi:10.1161/strokeaha.115.008229. Retrieved October 15, 2016, from http://stroke.ahajournals.org/content/46/10/2991

Longstreth, W. T., Dulberg, C., Manolio, T. A., Lewis, M. R., Beauchamp, N. J., O'leary, D., ... Furberg, C. D. (2002). Incidence, Manifestations, and Predictors of Brain Infarcts Defined by Serial Cranial Magnetic Resonance Imaging in the Elderly: The Cardiovascular Health Study. Stroke, 33(10), 2376-2382. doi:10.1161/01.str.0000032241.58727.49. Retrieved October 15, 2016, from http://stroke.ahajournals.org/content/33/10/2376.long

NHS Choices. Cerebrovascular disease - Risks and prevention. (2015, February 2). Retrieved October 15, 2016, fromhttp://www.nhs.uk/Conditions/Cerebrovascular-disease/Pages/Prevention.aspx

NHS Choices. Cerebrovascular disease - Introduction. (2015, February 2). Retrieved October 15, 2016, from http://www.nhs.uk/conditions/Cerebrovascular-disease/Pages/Definition.aspx

Oliveira Filho, J. (n.d.). Neuroimaging of acute ischemic stroke (S. E. Kasner, E. D. Schwartz, & J. F. Dashe, Eds.). Retrieved October 15, 2016, from http://www.uptodate.com/contents/neuroimaging-of-acute-ischemic-stroke

   Sandberg, J. (2016, February 5). Stroke Fact Sheet. Retrieved October 19, 2016, from http://www.strokeassociation.org/idc/groups/stroke-public/@wcm/@hcm/@sta/documents/downloadable/ucm_485076.docx