Economics of Inadvertence in Brain MRI Research Could Save Lives

Canadian researchers have shown that strategies customized to the health characteristics of research participants are needed to manage cost-effectively and ethically unexpected clinical findings in imaging research studies of the human brain.

The problem of how abnormalities of potential clinical relevance that are discovered unexpectedly regarding research involving magnetic resonance imaging (MRI) should be handled in the framework of entirely experimental brain imaging has been a topic of ongoing debate. The researchers, investigators from the University of British Columbia (Vancouver, Canada), applied health economics modeling to the case of intracranial aneurysms, a potentially fatal brain disorder if left untreated, in human subjects presumed to be neurologically healthy.

In a different approach than existing recommendations that have focused on the needs of individual laboratories and institutions, the researchers' analysis revealed that the best management of incidental findings should vary depending on the characteristics of research volunteers. For instance, women with a family history of aneurysm should undergo full radiologic examination before enrollment, while no endeavor should be taken towards detection of brain aneurysms in men without family history. The study also additional changes the research setting by showing that prescreening of brain scans by students and professionals who have not been trained in neuroradiology, a standard of practice across many research laboratories, is not cost-effective use of resources in any group of research volunteers.

Incidental findings were reported in 2% - 8% of healthy research volunteers and with the widespread growth in brain imaging research on one hand, and qualitative improvements in the precision of brain imaging modalities on the other hand, increasing numbers of healthy individuals can expect to be faced with such unanticipated findings in the future.

"Incidental findings are a challenge for researchers who do neuroimaging,” said Dr. Judy Illes, director of the National Core for Neuroethics, University of British Columbia, who has been studying the issues from a neuroethics point of view for the past 10 years. She noted that this is the first time policy-making issues based on the principles of welfare economics are combined with theoretic analysis from biomedical ethics to bring solutions to a problem that has such magnitude for the brain sciences.

This topic will be discussed in a future issue of Value in Health, the official journal of the International Society for Pharmacoeconomics and outcomes Research.

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