TY - JOUR
T1 - Cost Analysis of the STONE Randomized Trial
T2 - Can Health Care Costs be Reduced One Test at a Time?
AU - Melnikow, Joy
AU - Xing, Guibo
AU - Cox, Ginger
AU - Leigh, J Paul
AU - Mills, Lisa D
AU - Miglioretti, Diana L
AU - Moghadassi, Michelle
AU - Smith-Bindman, Rebecca
PY - 2016/1/12
Y1 - 2016/1/12
N2 - 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
AB - 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
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U2 - 10.1097/MLR.0000000000000487
DO - 10.1097/MLR.0000000000000487
M3 - Article
C2 - 26759975
AN - SCOPUS:84954349663
JO - Medical Care
JF - Medical Care
SN - 0025-7079
ER -