Less is more, at least when it comes to certain medical procedures.
That was the conclusion of a recent study by the American Heart Association (AHA) and reported here in a recent issue of Healthcare Business Weekly Update. Researchers compared the use of drug-eluting stents (DES) in 2004-06 to 2007, when their use decreased by nearly 25 percent. Using data from the Evaluation of Drug-Eluting Stents and Ischemic Events registry, the study found that limiting the use of DES did not increase the risk of death or heart attack, and only slightly raised the need for repeat angioplasty procedures. In fact, because the stents were reserved for use on higher risk patients, healthcare costs were reduced by an average of $410 per patient. When multiplied by the estimated 1 million angioplasty procedures performed annually, the United States is able to save nearly 400 million a year.
A recent story in Newsweek corroborates this research, and suggests that the use of DES weren’t the only medical procedures being overused. The article goes on to state that some common tests and procedures aren’t just expensive, but can do more harm than good.
“There are many areas of medicine where not testing, not imaging, and not treating actually result in better health outcomes,” says Dr. Rita Redberg, professor of medicine at the University of California, San Francisco, and editor of the Archives of Internal Medicine.
The problem is that “in otherwise healthy people,” screenings can lead to false positives, and cascading tests and procedures for possible problems that might have been harmless, or gone away on their own, the article says.
From PSA tests for prostate cancer (which more than 20 million U.S. men undergo every year) to surgery for chronic back pain to simple antiobiotics for sinus infection, a remarkable number and variety of tests and treatments are now proving either harmful or only as helpful as a placebo.
The article doesn’t dismiss the benefits of progressive medicine; instead, it lists the procedures that have saved lives and eased suffering for millions:
Screening tests like mammograms…can lead to early treatment of breast cancer, especially for women with hereditary risk or a strong family history of the disease. For cancer patients who report back pain, MRIs can prove invaluable for spotting tumors that have metastasized to the bones, allowing doctors to intervene before it’s too late. The years between 1980 and 2004 saw a 50 percent decline in the death rate from coronary heart disease thanks to better treatments and drugs that reduce cholesterol and blood pressure. At least 7,300 lives are saved every year thanks to colonoscopies.
But the flip side is that procedures are being overprescribed, like colonoscopies for the elderly, which can often harm them, and CT scans for the injured. A study published by John Hopkins noted the rise in MRIs and CT use in emergency departments over a 10 year period, from 1998 to 2007. The Hopkins team found that patients with injury-related conditions were three times more likely to get a CT or MRI scan in 2007 than they were in 1998. But the team also found that diagnosis of life-threatening conditions, such as a cervical spine fracture or liver laceration, rose only slightly.
Part of the problem is compensation: according to the Newsweek article, Medicare pays physicians more than $100 million a year for screening colonoscopies; still other procedures, like angioplasty, bypass surgery and stenting are not improving cardiac patients’ lives; but instead costing Medicare more than $1.6 billion a year.
The solution? The study published by the AHA didn’t directly identify which patients are the best candidates for DES, although other studies are currently underway using similar patient registries to address it. And research shows that low risk heart patients can benefit more from noninvasive treatments like drugs (beta blockers, cholesterol-lowering statins, and aspirin), exercise, and a healthy diet.
With the push for reducing healthcare costs while improving care, it’s an issue that will most probably continue to be explored.
