Variation in Downstream Relative Costs Associated With Incidental Ovarian Cysts on Ultrasound

Purpose: To explore variation in downstream relative costs associated with ovarian cysts incidentally detected on ultrasound. Methods: For 200 consecutive incidental ovarian cysts on ultrasound, ultrasound reports were classified in terms of presence of a radiologist recommendation for additional imaging. All downstream events (imaging, office visits, and surgery) associated with the cysts were identified from the electronic health record. Medical costs associated with these downstream events were estimated using national Medicare rates. Average cost per cyst was stratified by various factors; cost ratios were computed among subgroups. Results: Average costs per cyst were 1.9 times greater in postmenopausal than premenopausal women. Relative to when follow-up imaging was neither recommended nor obtained, costs were 1.1 times greater when follow-up imaging was recommended but not obtained, 5.1 times greater when follow-up imaging was both recommended and obtained, and 8.1 times greater when follow-up imaging was obtained despite not being recommended. Costs were 2.5 times greater when the radiologist underrecommended follow-up compared with Society of Radiologists in Ultrasound (SRU) guidelines for management of ovarian cysts, 3.0 times greater when the ordering physician overmanaged compared with the radiologist's recommendation, as well as 1.7 times and 3.8 times greater when the ordering physician undermanaged and overmanaged compared with SRU guidelines, respectively. Four ovarian neoplasms, although no ovarian malignancy, were diagnosed in the cohort. Conclusion: Follow-up costs for incidental ovarian cysts are highly variable based on a range of factors. Radiologist recommendations may contribute to lower costs among patients receiving follow-up imaging. Such recommendations should reflect best practices and support the follow-up that will be of likely greatest value for patient care.