We hear a lot about the wonders of genetic testing, how it can revolutionize medicine and find cures for fatal diseases.
A new study from the University of Michigan also shows how it can waste a half a billion dollars a year.
Researchers at the university examined testing for inherited thrombophilia, a genetic quirk that can indicate a patient’s likelihood of developing dangerous blood clots.
It sounds like a useful test to have. But, according to the researchers, knowing that you have the trait will not change your treatment.
“It really is one of these tests where there is no benefit to patients in the hospital,” said Dr. Christopher Petrilli, a University of Michigan hospitalist who coauthored the study. He noted that people who develop blood clots are treated with the same anticoagulant drugs, whether they have the gene or not.
Nonetheless, the study estimated the cost of the tests between $300 million and $670 million annually; Medicare received claims 280,000 times for the inherited thrombophilia test in 2014 alone, at a cost of between $1,100 to $2,400 a pop.
That means it cost taxpayers about a half a billion dollars without providing a discernible medical benefit.
The study only examined Medicare spending, which means it was likely billed to private insurers in countless other instances.
Unnecessary medical care is estimated to cost the United States between $750 billion and $1 trillion dollars a year, accounting for nearly a third of its overall spending on health care. Wasteful testing is one of the primary drivers of those costs.
Dr. Nitin Damle, president of the American College of Physicians, said it’s important for doctors to have conversations with their patients about the pros and cons of particular tests, to help weed out the ones that don’t offer a clinical benefit.
“You can explain to them that getting a test is not going to change therapy and that it’s just going to lead to more anxiety, unclear results, and more testing,” Damle said.
He noted, however, that many patients still want to have tests to understand their medical issues or predispositions they might pass to children. In those cases, it is appropriate for patients to pay out of pocket, instead of billing the government or private insurers. “That’s not an easy conversation to have to have with patients,” Damle said. “But if they’re not following the science, payers shouldn’t necessarily be responsible for covering that.”
In the case of inherited thrombophilia, Petrilli said, doctors appeared to be complicit in the waste — possibly due to fear of litigation or simply a shared desire to get the answers for their patients.
But the impact can easily snowball beyond the cost of the initial test. “It can lead to their family members being tested and increased anxiety for the entire family, which can lead to increased insurance premiums for health and life insurance,” he said. “It’s something that can follow you in your medical history even if it’s relatively meaningless.”
Petrilli said the researchers did find isolated circumstances where the inherited thrombophilia test could help — if, for example, a female patient was planning to undergo hormone therapy that would increase the potential for blood clotting. In that cases, the test could alert the patient to potential risks.
“Aside from that,” he said, “it’s relatively purposeless.”
The research was published in the Journal of Hospital Medicine, which periodically runs articles on unnecessary care using a plainspoken title: “Things We Do For No Reason.”