How Often Does Unnecessary Testing Occur?
The Congressional Budget Office has estimated that 5% of GDP is spent on tests & procedures that do not improve patient outcomes (Orsag testimony to US House, July 16, 2008). The Institute of Medicine reported that 30% of US health care is duplicative or unnecessary.
Several studies have specifically looked at lab test utilization.Lundberg estimated that 30% of laboratory tests did not provide new diagnostic information or alter therapy (JAMA 1980;243:2080). Wide variability in test utilization was noted between institutions and physicians. Donald Young has reported wide variability laboratory test utilization for the same DRGs between 3 hospitals within the University of Pennsylvania Health System. (Advance/Laboratory, October 2011).
A hospital audit at a tertiary care hospital in Orlando, Florida looked at duplicative orders for 6 laboratory tests that would not require a second result during a hospital admission (Clin Chem 2012; 58:1371). The tests included ANA, vitamin B12, TSH, ferritin and Iron/TIBC. More than 42,900 tests were ordered and 7 to 15% of these tests were duplicated. The laboratory cost for this unnecessary duplicated testing was $33,531.
Active surveillance of test ordering at the Souther Arizona VA Hospital revealed that 17% of orders were either not clinically indicated, ordered in error or were not the best test. Examples included 45% of orders for free PSA, 30% for free T3, 20% of vitamin D and 62% of HCV genotype. (ASCP Teleconference, February 28, 2013).
The same investigators also found that many tests were repeated too frequently. Examples include:
- 3.5% of HbA1c repeated within 21 days
- 5% of ferritin repeated within 14 days
- 6% of lipid panels repeated within 30 days
- 16% of hsCRP repeated within 3 months
- 10% of HCV genotype repeated
- 8% of FV Leiden mutations
- 1.4% of positive HCV antibody.
Clearly, overuse of laboratory tests is contributing to the cost of health care. Next week, we will investigate how often physicians follow-up on the large number of laboratory tests that they order
