Those unnecessary “little” tests add up: $5 billion/year in the US

Those unnecessary “little” tests add up: $5 billion/year in the US

Clinical question
What is the financial impact of the typical practices of little benefit used in primary care?

Bottom line
The routine “little” practices used in primary care add up when multiplied across the US healthcare system. Removing typical but not useful screening tests and procedures from health maintenance examinations and avoiding treating viral pharyngitis with antibiotics and high cholesterol levels with more expensive alternatives could put more than $5 billion back into the health care system. The list of not useful habits, their frequency of use in the United States, and their total costs can be found in the synopsis. (LOE = 5)

Kale MS, Bishop TF, Federman AD, Keyhani S. “Top 5” lists top $5 billion. Arch Intern Med 2011;171(20):1856-1858. [PubMed ® abstract] [Arch Intern Med extract]

Study design: Descriptive

Funding Source: Self-funded or unfunded

Setting: Population-based

A previous project conducted in 3 primary care specialties identified the “top 5” activities in each specialty that were thought to be common in practice but of little benefit to patients (Arch Intern Med 2011;171(15):1385-1390 [PubMed ® abstract]). In this report, the authors used data from 2 US surveys of practice — the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey — to estimate the frequency of these activities. They calculated the proportion of times each of the top 5 activities was performed as reported by these surveys and used this percentage to determine the additional costs to the health care system. The costs lined up as follows (in millions of US dollars for 1 year): General medical examination tests or procedures – Routine complete blood count in adults (56% of visits): $32.7 – Basic metabolic panel in adults (16%): $10.1 – Annual electrocardiography (19%): $16.6 – Urinalysis (18%): $3.4 Antibiotics for viral pharyngitis (41%): $116.3 Cough medicines for children (12%) : 10.3 Brand name statins (atorvastatin or rosuvastatin) instead of generic statins (34.6%): $5817 ($5.8 billion) Papanicolaou tests for patients younger than 21 years (2.9%): $47.7 DEXA scans for women younger than 64 years (1.4%): $527.4

Allen F. Shaughnessy, PharmD
Professor of Family Medicine
Tufts University
Boston, MA

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