The old saying goes, “When they say it ain't about the money, it's about the money.” Well, we have, finally, entered an era when everyone agrees, “It's about the money.” In this issue of Neurology: Clinical Practice, we focus on cost-effectiveness in the world of neurology. The article by Ho et al. outlines the utility of an MRI in patients with a first-time seizure and a negative head CT, noting that in 12% of these patients a lesion of importance may be discovered. Satya-Murti et al. describe the impact on the provider of use of a well-recognized but still somewhat new technology, vagal nerve stimulation. Callaghan et al. identify that 88% of diagnostic costs related to the common problem of peripheral neuropathy in the elderly are related to use of imaging and electrodiagnostics, and outline approaches to help contain costs. The article by Young et al. helps define issues to consider when reading cost-effectiveness articles, and the contribution of Cutter and Wang and the editorial by Satya-Murti put the scientific articles on cost-effectiveness into greater context. With the advent of the Affordable Care Act and Accountable Care Organizations, neurologists increasingly will be called upon to make economic decisions that have a real-life impact on their patients, and their own pocketbooks. We hope all these articles help our readers in making these complex decisions, and in future issues we will continue looking at the economic effects of diagnostic and treatment regimens from many points of view.
John R. Corboy, MD, FAAN
- © 2013 American Academy of Neurology
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