Cost Analysis of the STONE Randomized Trial: Can Health Care Costs be Reduced One Test at a Time? - PubMed (original) (raw)
Randomized Controlled Trial
Cost Analysis of the STONE Randomized Trial: Can Health Care Costs be Reduced One Test at a Time?
Joy Melnikow et al. Med Care. 2016 Apr.
Abstract
Background: Decreasing the use of high-cost tests may reduce health care costs.
Objective: To compare costs of care for patients presenting to the emergency department (ED) with suspected kidney stones randomized to 1 of 3 initial imaging tests.
Research design: Patients were randomized to point-of-care ultrasound (POC US, least costly), radiology ultrasound (RAD US), or computed tomography (CT, most costly). Subsequent testing and treatment were the choice of the treating physician.
Subjects: A total of 2759 patients at 15 EDs were randomized to POC US (n=908), RAD US, (n=893), or CT (n=958). Mean age was 40.4 years; 51.8% were male.
Measures: All medical care documented in the trial database in the 7 days following enrollment was abstracted and coded to estimate costs using national average 2012 Medicare reimbursements. Costs for initial ED care and total 7-day costs were compared using nonparametric bootstrap to account for clustering of patients within medical centers.
Results: Initial ED visit costs were modestly lower for patients assigned to RAD US: 423(423 (423(411, 434)comparedwithpatientsassignedtoCT:434) compared with patients assigned to CT: 434)comparedwithpatientsassignedtoCT:448 ($438, 459)(P<0.0001).Totalcostswerenotsignificantlydifferentbetweengroups:459) (P<0.0001). Total costs were not significantly different between groups: 459)(P<0.0001).Totalcostswerenotsignificantlydifferentbetweengroups:1014 ($912, 1129)forPOCUS,1129) for POC US, 1129)forPOCUS,970 ($878, 1078)forRADUS,and1078) for RAD US, and 1078)forRADUS,and959 ($870, 1044)forCT.Hospitaladmissionscontributedover501044) for CT. Hospital admissions contributed over 50% of total costs, though only 11% of patients were admitted. Mean total costs (and admission rates) varied substantially by site from 1044)forCT.Hospitaladmissionscontributedover50749 to $1239.
Conclusions: Assignment to a less costly test had no impact on overall health care costs for ED patients. System-level interventions addressing variation in admission rates from the ED might have greater impact on costs.
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