(P 349) THE COST OF SURVEILLANCE IN CALIFORNIA: MRI UTILIZATION IN RECURRENT EXTREMITY SOFT TISSUE SARCOMA

Objective: To evaluate the 5-year cost of MRI surveillance for extremity soft tissue tumor (STS) patients following surgical resection in California, stratified by recurrence.

Methods: This retrospective cohort study analyzed the 2017–2024 Humana Pearl Diver M170 Ortho dataset for California patients who underwent extremity STS resection between 2010-2018, using specific Current Procedural Terminology (CPT) codes for upper and lower extremities. MRI use over a five-year surveillance period was tracked via CPT codes. Recurrence was defined by CPT codes for subsequent tumor excision, radiation, or chemotherapy during the surveillance period. Financial burden was evaluated using insurer-reported reimbursement amounts. Key outcomes included number of MRIs, average cost per MRI, and total surveillance cost per patient.

Results: A total of 1,793 patients (765 upper extremity, 1,028 lower extremity) were identified (mean age 58.18 years; 53.5% female). Of these, 132 (7.36%) experienced recurrence, while 1,661 (92.6%) did not. Patients without recurrence underwent an average of 4.2 MRIs at a cost of $865.30 each, resulting in a total of $ 3,043.61 per patient for surveillance. Those with recurrence underwent an average of 6.7 MRIs at a cost of $983.29 each, resulting in a total of $5,240.95 per patient for surveillance. Stratification by extremity is detailed in Table 1.

Conclusion: Recurrent extremity STS patients required 59.5% more MRIs (6.7 vs. 4.2) and incurred 72% higher total surveillance costs ($5,241 vs. $3,044) over 5 years. The higher cost per-MRI in the recurrence group ($983 vs $865) further amplified this financial strain. These findings highlight the significant economic disparities in MRI surveillance for extremity STS, emphasizing the importance of risk stratification and tailored surveillance protocols to improve resource allocation, thereby balancing clinical benefits with economic sustainability in STS.

Table 1. Surveillance Metrics Stratified by Extremity and Recurrence Status