Best health tests and treatments often cost less

Those are the findings from High Value Care, a Consumer Reports and American College of Physicians' project

Published: April 2012

Think you need an expensive imaging test for your lower-back pain? Or that the best diabetes drug is one you see advertised on TV? Not necessarily, according to two new reports from the American College of Physicians and Consumer Reports, part of a joint project called High Value Care.

In both of those cases, the best care is usually a less expensive option, research suggests. For back pain, the report shows that people who had an MRI in the first month were eight times more likely to have surgery and had a more than five-fold increase in medical expenses—but they didn’t recover any faster than people who did not have an imaging test.

The American College of Physicians has identified 37 tests and treatments that may not provide good health-care value.

And for a drug to treat type 2 diabetes, the report shows that the best first choice for most people is metformin, a medication that has been around for almost two decades that you can buy as a generic for as little as $4 a month. It is actually more effective and safer than many newer drugs, including Actos (rosiglitazone), which costs about $230 to $370 for a month’s supply, or Januvia (sitagliptin), which costs about $265.

Less expensive care is better care in a number of other situations as well. The ACP has identified 37 sometimes surprising instances when common medical tests and treatments may not provide good health-care value for consumers.

Included in the list from the ACP are common ones like routinely ordering a CT scan or MRI for dizziness, and chest X-rays for people heading into surgery. In each case, research suggests that in many cases the risks of the tests outweigh the benefits, making any money spent on them money wasted.

“We’re not saying that expensive tests and treatments aren’t worthwhile,” says John Santa, M.D., director of the Consumer Reports Health Ratings Center. “They are, when they are proven to help save lives or help people live with less disability.” One good example: antiretroviral drugs to treat HIV infection. “Those drugs provide good value, even though they are expensive, because they work well against a very serious problem,” says Santa.

For each of those 37 topics, the ACP will publish a comprehensive medical article in the Annals of Internal Medicine documenting the evidence behind their recommendations, including the benefits, risks, and costs of each.

“The ACP and the Annals has a long history of taking an evidence-based approach to complicated medical issues,” says Santa. “That’s the same approach we take when considering what’s best for consumers.”

To date, the ACP has produced two such articles, one on lower-back pain and the other on diabetes drugs, and for each Consumer Reports has prepared two-page reports.

Download PDFs of the reports produced so far:

Read about our related project, called Choosing Wisely, with the American Board of Internal Medicine Foundation. To learn more about both projects and to get involved, go to ConsumerHealthChoices.org.

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