How to cut medical costs: Fewer tests
Last week a U.S. Food and Drug Administration panel weighed in on Amyvid. Most have probably never heard of this drug to identify brain plaque associated with Alzheimer's disease. The panel's recommendation was barely a bleep in the news.
What caught our attention had nothing to do with the safety or effectiveness of the drug. It was the conversation FDA reviewers had about the drug's usefulness in the real world that gets at the heart of a question Americans need to consider when it comes to health care: How do we weigh the benefits and costs of diagnostic tests?
Reviewers were asked to consider whether imaging to identify plaque in the brain would have any "clinical usefulness." There is no approved treatment that "consistently delays or reverses" the disease, according to the FDA. What can be gained by looking for signs of it in someone's brain?
It's a fair question. And it's a question that is much bigger than the field of Alzheimer's diagnostic tools.
Americans are notorious for undergoing tests and screenings for everything under the sun. We do it when there's no sign of a problem, from routine mammograms to pap smears. And the scans can be numerous when we suspect something is wrong.
Americans get about 70 million CT scans each year - ten times more than people in the United Kingdom. In 2007, MRI, CT or PET scans were ordered in 14 percent of emergency room visits - four times more than in 1996. Some people even get "preventative" whole body scans to look for problems.
There are benefits to catching some illnesses early if there are effective treatments. But scans are also costly, and they come with risks.
A Government Accountability Office study found Medicare spending for imaging services in physician's offices more than doubled - to $14 billion - from 2000 to 2006. Cardiologists obtained 36 percent of their total Medicare revenue from in-office imaging in 2006 compared to 23 percent in 2000. And that doesn't include the cost for the roughly 250 million Americans who aren't insured by Medicare.
And it's not just the scans themselves that can be expensive. They can lead to costly follow-up tests, biopsies and other procedures that drive up health care costs.
Then there's exposure to radiation. A recent study found that CT scans performed in 2007 would lead to 29,000 future cancers over the next 20 to 30 years. About half those cancers will cause death.
The point is not to target an imaging scan related to diagnosing Alzheimer's, a devastating and heartbreaking disease. It's to remind that this country must get health spending under control.
That is going to mean addressing difficult questions about how we use the ever-advancing technology available for detecting disease. None of us - including patients and doctors - can treat scans as simply innocuous photographs of our bodies' insides. They bring risks. They can lead to unneeded treatments. And they contribute to escalating health care costs.
What caught our attention had nothing to do with the safety or effectiveness of the drug. It was the conversation FDA reviewers had about the drug's usefulness in the real world that gets at the heart of a question Americans need to consider when it comes to health care: How do we weigh the benefits and costs of diagnostic tests?
Reviewers were asked to consider whether imaging to identify plaque in the brain would have any "clinical usefulness." There is no approved treatment that "consistently delays or reverses" the disease, according to the FDA. What can be gained by looking for signs of it in someone's brain?
It's a fair question. And it's a question that is much bigger than the field of Alzheimer's diagnostic tools.
Americans are notorious for undergoing tests and screenings for everything under the sun. We do it when there's no sign of a problem, from routine mammograms to pap smears. And the scans can be numerous when we suspect something is wrong.
Americans get about 70 million CT scans each year - ten times more than people in the United Kingdom. In 2007, MRI, CT or PET scans were ordered in 14 percent of emergency room visits - four times more than in 1996. Some people even get "preventative" whole body scans to look for problems.
There are benefits to catching some illnesses early if there are effective treatments. But scans are also costly, and they come with risks.
A Government Accountability Office study found Medicare spending for imaging services in physician's offices more than doubled - to $14 billion - from 2000 to 2006. Cardiologists obtained 36 percent of their total Medicare revenue from in-office imaging in 2006 compared to 23 percent in 2000. And that doesn't include the cost for the roughly 250 million Americans who aren't insured by Medicare.
And it's not just the scans themselves that can be expensive. They can lead to costly follow-up tests, biopsies and other procedures that drive up health care costs.
Then there's exposure to radiation. A recent study found that CT scans performed in 2007 would lead to 29,000 future cancers over the next 20 to 30 years. About half those cancers will cause death.
The point is not to target an imaging scan related to diagnosing Alzheimer's, a devastating and heartbreaking disease. It's to remind that this country must get health spending under control.
That is going to mean addressing difficult questions about how we use the ever-advancing technology available for detecting disease. None of us - including patients and doctors - can treat scans as simply innocuous photographs of our bodies' insides. They bring risks. They can lead to unneeded treatments. And they contribute to escalating health care costs.
