Table 3. Claim Line–Level Spending.
| Service | Spending per 1000 individuals, $ (95% CI)a | ||||
|---|---|---|---|---|---|
| 2014 | 2015 | 2016 | 2017 | 2018 | |
| Total | 52 765.5 (51 952.3-53 578.6) | 52 194.4 (51 314.1-53 074.7) | 50 783.0 (49 971.8-51 594.3) | 47 752.7 (46 951.0-48 554.4) | 46 921.7 (46 593.7-47 249.7) |
| Prescription drug | 26 523.0 (25 726.2-27 319.9) | 26 222.4 (25 379.0-27 065.9) | 23 833.9 (23 056.7-24 611.0) | 22 104.0 (21 335.4-22 872.6) | 21 175.3 (21 148.7-21 201.9) |
| Opioid for acute back pain | 12 700.0 (12 234.4-13 165.6) | 14 540.8 (14 023.9-15 057.7) | 14 417.4 (13 946.9-14 888.0) | 12 643.1 (12 263.4-13 022.7) | 11 884.8 (11 882.7-11 886.9) |
| Oral antibiotic for acute upper respiratory or external ear infections | 1293.5 (1286.5-1300.5) | 1314.4 (1308.0-1320.9) | 1167.9 (1162.6-1173.2) | 1142.4 (1136.0-1148.8) | 977.1 (977.0-977.2) |
| Concurrent use of ≥2 antipsychotic medications | 7816.6 (7172.7-8460.5) | 7251.8 (6587.4-7916.2) | 5975.4 (5358.0-6592.7) | 6338.2 (5671.0-7005.5) | 6555.4 (6529.7-6581.0) |
| Antidepressant monotherapy in bipolar disorder | 58.0 (52.4-63.5) | 52.2 (43.8-60.6) | 50.5 (42.5-58.4) | 52.5 (42.2-62.8) | 50.0 (43.4-56.6) |
| NSAID in patient with hypertension, heart failure, or CKD | 4652.2 (4593.6-4710.8) | 3058.7 (3007.5-3109.9) | 2216.5 (2180.4-2252.5) | 1922.2 (1887.1-1957.2) | 1703.8 (1703.3-1704.4) |
| Antibiotic for adenoviral conjunctivitis without secondary infection or other conditions | 2.8 (2.4-3.1) | 4.6 (4.1-5.1) | 6.2 (5.8-6.6) | 5.7 (5.3-6.0) | 4.1 (2.8-5.4) |
| Diagnostic test | 2533.2 (2519.1-2547.3) | 2454.6 (2441.4-2467.9) | 2368.3 (2356.0-2380.6) | 2448.1 (2435.9-2460.3) | 2443.6 (2417.7-2469.5) |
| Brain imaging for simple syncope with normal neurological exam | 199.0 (195.5-202.5) | 212.7 (208.3-217.1) | 167 .2 (164-170.4) | 163.8 (160.3-167.2) | 163.1 (159.6-166.5) |
| Imaging for uncomplicated headache without neurological symptoms | 674.3 (667.1-681.5) | 604.5 (597.4-611.7) | 528.2 (521.7-534.7) | 519.0 (512.7-525.2) | 515.2 (512.1-518.2) |
| Imaging for acute low back pain without red flag signs | 169.2 (165.6-172.7) | 150.7 (147.8-153.7) | 199.3 (195.6-203.0) | 189.9 (186.4-193.5) | 187.4 (185.5-189.2) |
| Immunoglobulin G or immunoglobulin E test in the evaluation of allergy | 36.5 (35.0-38.0) | 39.1 (37.4-40.7) | 53.7 (51.7-55.7) | 56.6 (54.9-58.3) | 54.6 (52.9-56.3) |
| Routine diagnostic test for chronic urticaria | 7.9 (7.0-8.9) | 7.2 (6.4-8.1) | 10.4 (9.3-11.6) | 8.5 (7.7-9.4) | 7.2 (1.2-13.1) |
| Electroencephalogram for headache | 279.7 (274.3-285.0) | 276.2 (271.2-281.3) | 284.7 (279.8-289.5) | 289.2 (284.6-293.8) | 285.5 (277.5-293.5) |
| Carotid duplex ultrasound for simple syncope with normal neurological examination | 561.0 (558.1-563.8) | 594.8 (591.9-597.6) | 586.9 (583.6-590.2) | 630.5 (627.1-633.9) | 624.5 (623.4-625.5) |
| CT scan of head or brain for sudden-onset hearing loss | 101.1 (95.2-107.1) | 102.1 (98.4-105.8) | 97.4 (94.9-99.9) | 110.1 (107.6-112.5) | 117.1 (113.8-120.3) |
| Imaging for uncomplicated acute rhinosinusitis | 188.6 (184.8-192.4) | 192.4 (187.9-196.8) | 191.4 (187.4-195.4) | 211.5 (207.3-215.7) | 197.7 (195.0-200.4) |
| Coronary artery calcium scoring for known CAD | 33.3 (28.5-38.0) | 36.2 (31.9-40.5) | 36.3 (32.3-40.3) | 51.3 (47.2-55.4) | 60.8 (38.0-83.6) |
| CT scan for emergency department evaluation of dizziness | 281.1 (278.0-284.2) | 237.7 (234.9-240.4) | 212.1 (209.4-214.8) | 217.1 (214.4-219.9) | 230.3 (228.0-232.7) |
| Bleeding time test | 1.6 (1.4-1.7) | 1.1 (1.0-1.3) | 0.7 (0.7-0.8) | 0.6 (0.5-0.6) | 0.4 (−0.3-1.0) |
| Preventive screen | 13 385.5 (13 340.7-13 430.4) | 12 971.5 (12 928.9-13 014.1) | 12 717.7 (12677.4-12 758.0) | 11 575.9 (11 537.0-11 614.8) | 11 456.1 (11 449.7-11 462.4) |
| Cervical cancer screen in woman not at high risk with adequate prior screening | 1386.0 (1383.1-1388.9) | 1293.3 (1290.6-1296.1) | 1187.7 (1185.2-1190.3) | 1080.1 (1077.7-1082.4) | 939.2 (939.1-939.3) |
| Annual ECG or cardiac screen in patient without symptoms or risk factors | 607.0 (600.3-613.7) | 468.7 (464.0-473.5) | 311.8 (307.2-316.5) | 392.2 (388.2-396.1) | 489.7 (488.6-490.8) |
| DEXA screen for osteoporosis in woman aged <65 y or man aged <70 y | 3.5 (3.2-3.8) | 2.4 (2.2-2.6) | 2.3 (2 .1-2.5) | 1.8 (1.6-1.9) | 1.9 (−3.3-7.0) |
| Unnecessary colorectal cancer screening in adult aged 50-75 y | 6085.0 (6046.2-6123.8) | 5968.7 (5931.6-6005.7) | 5748.5 (5713.9-5783.1) | 5347.1 (5313.5-5380.8) | 5524.8 (5523.3-5526.4) |
| Screening for vitamin D deficiency | 654.3 (650.6-657.9) | 640.1 (636.7-643.6) | 705.0 (701.8-708.1) | 429.5 (426.9-432.2) | 358.3 (358.2-358.4) |
| Cardiac stress test or advanced imaging for patient without symptoms or risk factors | 4649.7 (4628.7-4670.7) | 4598.2 (4578.1-4618.3) | 4762.4 (4742.7-4782.1) | 4325.2 (4306.5-4343.9) | 4142.2 (4138.9-4145.4) |
| Preoperative test | 4009.5 (3989.8-4029.1) | 3761.9 (3737.5-3786.2) | 3291.1 (3267.7-3314.4) | 3116.2 (3097.4-3135) | 3168.6 (3150.3-3186.9) |
| Preoperative laboratory test in patient without significant systemic illness before elective low-risk surgery | 3529.4 (3510.2-3548.7) | 3263.6 (3239.6-3287.6) | 2874.0 (2850.9-2897.1) | 2745.6 (2727.1-2764.2) | 2821.8 (2821.7-2821.8) |
| Preoperative ECG, chest radiograph, or pulmonary function test in patient without significant systemic illness before low-risk surgery | 396.8 (394.4-399.1) | 429.4 (426.1-432.7) | 350.7 (348.3-353.1) | 303.8 (301.8-305.9) | 282.5 (282.3-282.8) |
| Preoperative echocardiogram or stress test before low- or intermediate-risk noncardiac surgery | 79.5 (76.2-82.8) | 67.6 (64.8-70.3) | 65.0 (62.7-67.3) | 64.9 (62.6-67.2) | 62.6 (44.3-80.8) |
| Routine pulmonary function test before cardiac surgery | 3.8 (3.5-4.0) | 1.3 (1.2-1.5) | 1.3 (1.2-1.5) | 1.8 (1.6-2.0) | 1.8 (0.3-3.3) |
| Invasive procedure | 6314.2 (6160.2-6468.3) | 6783.9 (6536.9-7030.9) | 8572.1 (8344.2-8800.1) | 8508.5 (8284.7-8732.2) | 8678.1 (8352.8-9003.4) |
| Renal artery revascularization | 1086.8 (1025.7-1147.9) | 1261.1 (1176.8-1345.3) | 1532.2 (1476.4-1588.0) | 1453.9 (1385.6-1522.1) | 1582.9 (1375.1-1790.6) |
| Arthroscopic lavage and debridement for knee osteoarthritis | 149.6 (143-156.2) | 152.4 (146.3-158.6) | 146.2 (139.7-152.7) | 126.8 (121.3-132.4) | 124.7 (58.8-190.6) |
| Peripherally inserted central catheter in patient with stage 3-5 CKD | 1610.2 (1475.0-1745.4) | 2252.4 (2022.9-2481.9) | 3940.8 (3722.6-4159.1) | 3626.2 (3416.7-3835.7) | 3596.0 (3356.2-3835.9) |
| Coronary angiogram in patients without symptoms or risk factors | 3467.7 (3426.9-3508.5) | 3118 (3083.3-3152.7) | 2952.9 (2918.5-2987.2) | 3301.6 (3263.0-3340.3) | 3374.5 (3346.3-3402.7) |
Abbreviations: CAD, coronary artery disease; CKD, chronic kidney disease; CT, computed tomography; DEXA, dual energy x-ray absorptiometry; ECG, electrocardiogram; NSAID, nonsteroidal anti-inflammatory drug.
a
For detailed measure specifications, please see eTable 1 in the Supplement.