TABLE 6.

Estimates of Wasted Clinical Spending in the United States

Clinical Service	Total Annual Dollars ($ in Millions) Wasted	% of U.S. Health Care Spending	References and Sources Data
Excessive antibiotic use for viral upper respiratory infections and otitis media	$525–$546a	0.03	Capra et al. 2000; Gonzalez, Steiner, and Sande 1997; Kaplan, Wandstrat, and Cunningham 1997; Subcommittee on Management of Acute Otitis 2004
Avoidable emergency department use	$3,000 (upper bound)	0.16	Calculations from MEPSb 2004 data
Avoidable hospitalizations of nursing-home patients	$7,500 (upper bound)	0.4	Calculations from MCBSc 2003 data
Overuse of cytology for cervical cancer screening	$630 –$4,000	0.03–0.21	American Cancer Society 2007; Kim,Wright, and Goldie 2002; Solomon, Breen, and McNeel 2007
Inappropriate hysterectomies	$1,119	0.06	Broder et al. 2000; Farquhar and Steiner 2002; Hurskainen et al. 2004
Unnecessary hospital admissions in ED triage of chest-pain patients	$4,443	0.23	Gaspoz et al. 1994; Kontos et al. 2003; Society of Chest Pain Centers 2007
Overuse of noninvasive radiologic imaging	$18,210–$33,333	0.96–1.75	Baker 2003; Levin and Rao 2004; Rothenberg and Korn 2005
Inappropriate spinal-fusion surgeries	$11,118	0.59	Deyo 2007; Deyo et al. 2005; Deyo, Nachemson, and Mirza 2004; Grob, Humke, and Dvorak 1995; Katz et al. 1997; Kuntz et al. 2000; Malter and Weinstein 1996
Total	$36,044–$65,099	1.90–3.42

^aMillions of dollars and adjusted to 2006 US$. Estimates reflect percentage of waste estimates derived from literature, and ranges indicate upper and lower bounds. Population estimates standardized to the 2006 U.S. population.

^bMEPS (Medical Expenditure Panel Survey).

^cMCBS (Medical Current Beneficiary Survey).