Neuromuscular ultrasound

In the United States, the increasing cost of health care continues to be a serious medical, personal, and financial crisis for patients, doctors, and hospitals, as well as for businesses, insurers, and the government.1 On the therapeutic side, it is becoming commonplace for some new pharmaceuticals to cost tens to hundreds of thousands of dollars a year. On the diagnostic side, advanced imaging, especially MRI, is increasingly used. Although highly efficacious, its use is also driving up health care costs. These high costs have resulted in an increasing bureaucracy of insurance regulations, denials, appeals, and peer reviews. The increasing cost of health care has put the focus on value. Because value is defined as quality divided by cost, a test such as MRI, which has a high quality but also a high cost, has its value limited to certain situations. What one ideally wants in a diagnostic test is high quality and low cost. Neuromuscular ultrasound (NMUS) is such a diagnostic test whose time has come. In this issue of Neurology ®, Mandeville et al.2 report the robust cost-effectiveness of NMUS used in addition to electrodiagnostic testing in focal neuropathies.