A Strange World

In a world where it is assumed that medical costs will always go up at a rate which significantly (if not vastly) exceeds inflation, one would think that a new, non-invasive and highly accurate test which can be administered at a fraction of the cost of its predecessor would be, well, good news. So the announcement of a new form of CT scan that is likely to replace angiograms seems promising:

The scans can largely replace diagnostic angiograms, the expensive, onerous way of looking for blockages in arteries, and can make diagnosis so easy that doctors would not hesitate to use them. They are expected to cost about $700, compared with about $4,000 for an angiogram.

According to Epix Pharmaceuticals, this new technology"may provide an alternative for the 4.5 million diagnostic X-ray angiograms performed in the United States annually at a total cost to the healthcare system of over $9 billion.". But it seems that some doctors and industry analysts can find a dark cloud for every silver lining. As the New York Times editorializes,

From a patient's viewpoint, the heart scans have a lot to recommend them. They take seconds to conduct and require no recovery time, whereas an angiogram takes 45 minutes and requires hours of recuperation. The scans can also spot danger spots in the arteries that might be missed by an angiogram. The downsides are that heart scans subject a patient to far more radiation than most diagnostic procedures, and they are quite apt to spot things that are of no medical consequence but that one might feel compelled to do something about. In the end, the patient might undergo additional tests and procedures - all of them carrying some degree of risk - to eliminate a potential problem that did not really need to be fixed.

At first blush, it will take a lot of overuse of this new technology before we're losing money on the deal. Epix suggests a savings of $9 billion per year - but using the Times' figures, we're looking at savings approaching $15 billion per year. Those figures translate into somewhere between 12 million and 21 million new prescriptions for cardiac diagnostic imaging before we're losing money. (That's four to six times the rate at which angiograms are presently ordered.) Whatever skepticism is coming from within the industry, let's hope doctors are more responsible than that, in wildly prescribing this new test, or (as is implicit in some of the "doom and gloom" cost forecasts) in overprescribing it to pay for expensive new equipment.

But one might also note that this highlights something that few analysts have dared to interject into debates over the cost of medical care. It is possible for costs to come down - way down - for certain procedures. And it is possible that the ultimate result will be a vast cost savings over present diagnostic procedures, as imaging tests become less invasive and more accurate, and as methodological scientific study of the results of new imaging tests provide a science-based rationale for determining which medical treatments are most effective and when additional intervention is required.