Choosing Wisely: Highest-cost tests in outpatient neurology


Address correspondence to Dr Burke, RWJ Clinical Scholars Program, North Campus Research Complex, 2800 Plymouth Rd, Building #10, Room G016, Ann Arbor, MI 48109. E-mail:


Identifying the tests/procedures ordered by neurologists that contribute most to health care expenditures is a critical step in the process of creating the neurology top 5 list for the Choosing Wisely initiative. Using data from the 2007–2010 National Ambulatory Care Medical Survey, we found that $13.3 billion (95% confidence interval = $10.1–$16.5 billion) was spent on tests ordered at neurologist visits. The tests/procedures with the highest expenditures were magnetic resonance imaging (MRI; 51% of total expenditures; $7.5 billion), electromyography (EMG; 20% of expenditures; $2.6 billion), and electroencephalography (EEG; 8% of expenditures; $1.1 billion). MRI, EMG, and EEG should receive close scrutiny in the development of the neurology top 5 list. Ann Neurol 2013;73:679–683