Cost Analysis of the STONE Randomized Trial
Can Health Care Costs be Reduced One Test at a Time
Bibliographic Data
| ID | 9102398 |
|---|---|
| Authors | Joy Melnikow (0000-0002-9963-6089, Lee University), Guibo Xing (Lee University), Ginger Cox (Lee University), Paul Leigh (Lee University), Lisa Mills (0000-0002-6168-7008, Lee University), Diana L Miglioretti (0000-0002-5547-1833, Lee University), Michelle Moghadassi (Lee University), Rebecca Smith-Bindman, Rebecca Smith‐Bindman (0000-0003-1972-639X, Lee University) |
| Year | 2016 |
| Volume | 54 |
| Issue | 4 |
| Pages | 337-342 |
| Publication date | 2016-04-01 |
| Peer Reviewed | Yes |
| Open Access | No |
| Type | ARTICLE |
| Venue | Medical Care (JOURNAL) |
| Journal identifiers | ISSN: 0025-7079 • E-ISSN: 1537-1948 |
| Publisher | Ovid Technologies (Wolters Kluwer Health) (PUBLISHER) |
| DOI | 10.1097/mlr.0000000000000487 |
| PMID | 26759975 |
| OpenAlex | W2313017636 |
| Language | EN |
| References cited | 21 |
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 ($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
Emergency department · Health care · Medical costs · Randomized controlled trial · Total cost · Appendicitis Diagnosis and Management · Emergency Medicine · Kidney Stones and Urolithiasis Treatments · Medicine · Surgery · Ultrasound in Clinical Applications
| Citation velocity | historical |
|---|---|
| Highly cited | No |