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How much do they cost and what tests do you really need?

Posted Feb 01 2010 7:15pm

An article in today’s CBS Moneywatch.com reviews diagnostics tests, their costs, purpose, concerns and if then test is worth getting.   If you are considering getting a non-emergency MRI, mammogram, CT scan, or nuclear scan, be sure to read this article.  If you want to learn more about prices for these diagnostic tests, you can search the Outofpocket.com directory to find true prices for these services.

Chalk it up as one more symptom of our broken health-care system: Americans waste more than $250 billion per year on unnecessary medical tests and treatments, according to a Thomson Reuters health-care analytics report. Often, doctors order expensive, high-tech tests to rule out unlikely possibilities, reassure worried patients, or as a CYA strategy against a possible lawsuit. An American Journal of Preventive Medicine study found that in 43 percent of cases where healthy people went in for routine checkups, doctors ordered an X-ray, electrocardiogram, or urinalysis. So how can you be sure you’re not wasting your money on medical tests you don’t really need?

Unnecessary medical tests don’t just take money out of your pocket. They can expose you to radiation, cause mental stress, and kill a day or more. Not to mention their cumulative effect: ever-climbing insurance premiums .

MoneyWatch wanted to find out whether five commonly prescribed tests are worth getting: mammograms, CT scans, PSA prostate screening tests, nuclear heart scans and MRIs for lower back pain. So we talked to experts in preventative and family medicine and pored through the latest research about the risks and benefits of these tests, which can cost up to $2,000 or more a pop. What we found may surprise you.

Of course decisions about medical care are intensely personal, and everyone’s circumstances are slightly different. If there’s a key takeaway it’s this: Medical tests are not analogous to checking your car’s tire pressure. Sure there may be benefits, but there can also be negative consequences. Be sure to educate yourself on the downside.

CT Scan

  • Purpose: Non-invasive and painless, doctors use them to get detailed images of everything from cancerous tumors to signs of heart disease to bone injuries. You lie on an exam table that slides in and out of a machine. More than 70 million CT scans are done annually; 23 times the number in 1980, according to the Radiological Society of North America.
  • Cost: Varies widely; average price is $1,150 for a brain CT scan, $1,800 for a chest CT scan and $2,175 for an abdominal CT Scan
  • Concerns: Researchers are increasingly fearful that the scans’ radiation could lead to increased cancer risk and say that safer tests such as an ultrasound can sometimes do the job. Then, there’s the danger of medical error. Last August, 206 patients at Cedars-Sinai Medical Center in Los Angeles accidentally received eight times the normal amount of radiation during their CT scans. “A single CT scan for an isolated problem I’m not so concerned about. It’s when patients keep coming back for repeated exams that cumulative radiation starts to add up,” says Dr. Aaron Sodickson, assistant professor of radiology at Harvard Medical School.
  • Worth getting? If your doctor orders a non-emergency CT scan and you’ve already had at least one previously, “ask your doctor if there are alternative tests that can be done,” says Greg Morrison, chief operating officer of the American Society of Radiologic Technologists. If you will undergo the test, first ensure that the facility is accredited by the American College of Radiology and that technicians follow the ALARA (As Low as Reasonably Achievable) protocol, so you’ll receive the lowest possible dose of radiation.

PSA Prostate Cancer Test

  • Purpose: Doctors encourage men to get this simple blood lab test every year to help them avoid the second leading cause of death among U.S. males. But the PSA, or prostate specific antigen test, may do more harm than good.
  • Cost: About $45; up to $1,500 if the test leads to a biopsy
  • Concerns: The American Cancer Society does not support routine testing for prostate cancer, because of the risk of over diagnosis and overtreatment. Studies recently published in the New England Journal of Medicine found that PSA screening does find more prostate cancer, but the early detection does not translate into lives saved . For every man whose life is saved by early detection of prostate cancer, 48 others will undergo unnecessary treatment with possible side effects including impotence and incontinence.
  • Worth getting? Discuss your options with your doctor. Some men opt for regular PSA screenings, but not to have surgery or radiation therapy unless an aggressive cancer is detected.

Nuclear Heart Scan

  • Purpose: Doctors usually order these two- to four-hour tests after patients have had unexplained chest pain or pain brought on by exercise. The scans are designed to help detect narrowing of the arteries, damaged heart muscle, or to evaluate how well your heart is pumping blood. After a radioactive ‘tracer’ is injected into your veins, you take a stress test, walking on a treadmill or riding a stationary bike at increasing speeds. Then photographs are taken, showing your heart after strenuous exercise.
  • Cost: About $2,000
  • Concerns: Although this type of imaging can be useful for diagnosing heart disease, it’s overused. A pilot study of 3,035 scans for the American College of Cardiology (funded by insurers and cardiology groups) found that about 18 percent of the nuclear heart scans were done unnecessarily ; another 16 percent were ambiguous.
  • Worth getting? Ask your doctor whether an alternative test is available, such as a stress echocardiogram , which does not involve exposure to radiation and costs about $1,000. Discuss the amount of radiation you’ve been exposed to in the past to determine whether you may want to avoid future radiation, when possible.

Lower-Back MRI

  • Purpose: A spinal magnetic resonance imaging (MRI) test can find changes in the spine and other tissues, infections, herniated discs, and tumors without using radiation. You typically lie on a moveable table that slides into a tube surrounded by a magnet. Newer standing, or open, MRI machines are also available.
  • Cost: About $2,000
  • Concerns: MRIs can show every bump and lump, which may lead to procedures causing more harm than good. The Health Affairs journal found that the increasing availability of MRI is linked to an increase in surgery for lower back pain even though symptoms for most back pain sufferers often resolve themselves without invasive surgery. The researchers theorized that doctors ordering the MRIs have a tendency to find something to blame in the resulting images.
  • Worth getting? Experts say that if you have lower back pain, wait at least a month before submitting to an MRI. “The main reason you’d have an MRI of your lower back is if you’re going to have surgery,” says Dr. Daniel Merenstein, Assistant Professor and Director of Research in Family Medicine at Georgetown University Medical Center. “But for routine low back pain, surgery has not been shown to be any better than Motrin or other non-steroidal anti-inflammatory drugs or acupuncture.”

Mammogram

  • Purpose: The 10-minute X-ray procedure can be done for breast-cancer screening purposes in the absence of symptoms or for diagnosis purposes after a doctor detects a change in a woman’s breast.
  • Cost: About $125
  • Concerns: For years, women were advised to have routine screening mammograms every year or two starting at age 40. Last fall, the U.S. Preventative Services Task Force recommended less routine screening, concerned that mammograms on women in their 40s yield a high number of false positives. For women without risk factors, such as a history of breast cancer among close relatives, the panel now recommends biennial screenings starting at 50 and until age 74.
  • Worth getting? Although the panel advises women in their 40s without significant risk factors to discuss the usefulness of a mammogram with their doctors, leading breast cancer experts, including American Cancer Society and Susan G. Komen for the Cure , still strongly recommend women get screening mammograms beginning in their 40s. “The American Cancer Society acknowledges the limitations of mammography [but] overwhelmingly believe[s] the benefits of screening women 40 to 49 outweigh its limitations,” Dr. Otis Brawley, chief medical officer of the American Cancer Society said, in a statement. “We believe the evidence does show there is survival benefit for women who get screening in their 40s, although we acknowledge that benefit is not great,” says Susan Brown, director of health education for Susan G. Komen for the Cure. So until the medical community reaches a consensus, it seems best to get the mammogram.

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