Cost Analysis of the STONE Randomized Trial: Can Health Care Costs be Reduced One Test at a Time?
Med Care
; 54(4): 337-42, 2016 Apr.
Article
em En
| MEDLINE
| ID: mdl-26759975
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. RESEARCHDESIGN:
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 ($411, $434) compared with patients assigned to CT $448 ($438, $459) (P<0.0001). Total costs were not significantly different between groups $1014 ($912, $1129) for POC US, $970 ($878, $1078) for RAD US, and $959 ($870, $1044) 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 $749 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.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Cálculos Renais
/
Custos de Cuidados de Saúde
/
Sistemas Automatizados de Assistência Junto ao Leito
/
Serviço Hospitalar de Emergência
Tipo de estudo:
Clinical_trials
/
Diagnostic_studies
/
Health_economic_evaluation
Limite:
Adult
/
Female
/
Humans
/
Male
País como assunto:
America do norte
Idioma:
En
Ano de publicação:
2016
Tipo de documento:
Article