October 14th, 2014

Inappropriate Cardiac Stress Tests May Cost Half a Billion Dollars a Year

Inappropriate cardiac stress tests may cost the U.S. healthcare system as much as half a billion dollars each year, according to a new study published in the Annals of Internal Medicine.

Joseph Ladapo and colleagues set out to analyze long-term trends in the use of cardiac stress testing in the U.S. Using data from national surveys, they found that from the years 1993-1995 to 2008-2010, the use of cardiac stress tests more than doubled, from 1.6 million  to 3.8 million procedures each year. This represented an increase in the rate of procedures from 28 to 45 per 10,000 visits to the doctor.

The overall growth in these tests was largely explained by changes in the patient population. But the growth in cardiac stress tests with imaging — far more expensive than a simple treadmill test — was not explained by these changes. Use of these imaging tests — most often a nuclear stress test, which involves exposure to radiation —  have exploded in popularity and are far more expensive than the much simpler treadmill test.

The investigators calculated that from 2005-2010, 30% of imaging stress tests were performed without an appropriate reason, and these tests cost $494 million annually. The radiation received by patients during these inappropriate procedures could lead to 491 patients developing cancer later in life. By contrast, inappropriate stress testing without imaging cost only $7.7 million each year.

In recent years, there has been a slight decrease in the use of these tests as medical guidelines have stated emphatically that these procedures are inappropriate in patients without chest pain or other significant symptoms.

The cost of inappropriate testing “reduces society’s ability to provide other health services or expand access to care for uninsured and underserved populations.” the authors write. “Our results therefore support and further refine concerns voiced by professional societies and insurers about use.”

Note: Comments on this news story are closed, but please join the discussion about this topic over at Harlan Krumholz’s interview with Joseph Ladapo, lead author of this study.

3 Responses to “Inappropriate Cardiac Stress Tests May Cost Half a Billion Dollars a Year”

  1. Joel Wolkowicz, MDCM says:

    Not surprising. Cardiologists make a ton of money with self referrals. And more patients receive primary care from mid levels, many of whom have little concept of appropriate choices for stress testing. I see mid levels ordering nuclear stress tests to clear stable outpatients to undergo endoscopy.

  2. Jean-Pierre Usdin, MD says:

    That is not only a question of “a ton of money” but our peers and media are really found of “cardio vascular diseases are the first cause of death in the world”. By the way it is difficult for a GP (or second zone cardiologist as I consider myself) to explain and explain again “there is no need for stress test (even if upgraded with non invasive echo) your symptoms are not related to coronary problem.
    “But doctor my neighbour died suddenly yesterday without any symptom before…. Let’s check please”
    This is a non ending story and not a ton of money story.
    Media, our well introduced peers, and health persona grata would have better to insist and insist again on preventive measures.

  3. Thierry Legendre, MD says:

    About the perception of risk by patient, read the article of the New England Journal of Medecine 2014;371:1549 ” invisible risks, emotional choices…”;
    Mammography screening is the subject but it applies very well to stress testing.