Table 4. Claim-Level Spending.
| Service | Spending per 1000 individuals, $ (95% CI)a | ||||
|---|---|---|---|---|---|
| 2014 | 2015 | 2016 | 2017 | 2018 | |
| Total | 160 070.4 (158 999.8-161 141.0) | 160 321.3 (156 308.0-164 334.7) | 145 722.7 (144 503.2-146 942.2) | 141 873.7 (140 601.3-143 146.0) | 144 741.1 (144 287.5-145 194.7) |
| Prescription drug | 26 523.4 (25 726.5-27 320.2) | 29 641.6 (28 519.0-30 764.3) | 26 830.3 (25 783.2-27 877.5) | 25 314.2 (24 223.3-26 405.1) | 24 532.0 (24 491.5-24 572.5) |
| Opioid for acute back pain | 12 700.0 (12 234.4-13 165.6) | 14 540.4 (14 023.5-15 057.3) | 14 417.7 (13 947.2-14 888.3) | 12 642.9 (12 263.2-13022 .5) | 11 885 (11 882.9, 11 887.1) |
| Oral antibiotic for acute upper respiratory or external ear infections | 1293.4 (1286.5-1300.4) | 1314.5 (1308.0-1320.9) | 1167.9 (1162.6-1173.2) | 1142.3 (1136.0-1148.7) | 977.l (977.0-977.2) |
| Concurrent use of ≥2 or more antipsychotic medications | 7816.9 (7173.0-8460.8) | 10671.3 (9676.1-11 666.4) | 8971.6 (8036.9-9906.3) | 9548.7 (8526.7-10 570.7) | 9912.0 (9872.1-9951.9) |
| 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 | 4652.3 (4593.6-4710.9) | 3058.7 (3007.5-3109.9) | 2216.5 (2180.4-2252.5) | 1922.1 (1887.1-1957.2) | 1703.8 (1703.2-1704.4) |
| 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 | 7824.3 (7703.4-7945.2) | 7649.8 (7580.6-7719.0) | 7855.2 (7794.0-7916.3) | 7939.8 (7887.0-7992.6) | 7951.9 (7721.1-8182.6) |
| Brain imaging for simple syncope with normal neurological exam | 1040.8 (1020.4-1061.1) | 1123.4 (1102.3-1144.5) | 1209.1 (1190.4-1227.7) | 1192.1 (1173.3-1211.0) | 1227.0 (1206.2-1247.8) |
| Imaging for uncomplicated headache without neurological symptoms | 1368.4 (1351.9-1384.9) | 1265.1 (1249.6-1280.6) | 1156.1 (1141.4-1170.9) | 1171.6 (1157.9-1185.4) | 1175.9 (1168.7-1183.1) |
| Imaging for acute low back pain without red flag signs | 372.5 (364.6-380.4) | 356.7 (349.7-363.8) | 453.6 (445.2-462.0) | 430.5 (422.7-438.4) | 426.5 (422.3-430.7) |
| Immunoglobulin G or immunoglobulin E test in the evaluation of allergy | 103.5 (91.7, 115.2) | 106.1 (91.6-120.7) | 150.5 (119.8-181.3) | 165.8 (150.4-181.2) | 160.2 (144.2-176.1) |
| Routine diagnostic test for chronic urticaria | 29.9 (23.5-36.4) | 36.1 (25.1-47.0) | 35.8 (28.4-43.1) | 47.8 (39.4-56.3) | 44.4 (−41.1-129.9) |
| Electroencephalogram for headache | 410.4 (399.3-421.4) | 402.8 (392.5-413.1) | 413.1 (403.5-422.7) | 427.0 (416.9-437.2) | 424.0 (403.4-444.6) |
| Carotid duplex ultrasound for simple syncope with normal neurological examination | 2090.9 (2057.4-2124.3) | 2162.6 (2130.4-2194.7) | 2362.8 (2331.8-2393.9) | 2272.2 (2243.8-2300.7) | 2216.5 (2207.6-2225.4) |
| CT scan of head or brain for sudden onset hearing loss | 256.8 (152.5-361.1) | 232.1 (198.2-266.0) | 212.2 (193.2-231.2) | 226.6 (216.8-236.3) | 247.9 (231.9-263.8) |
| Imaging for uncomplicated acute rhinosinusitis | 595.3 (582.1-608.5) | 600.1 (586.4-613.8) | 623.5 (608.7-638.2) | 684.3 (669.2-699.4) | 632.4 (623.3-641.5) |
| Coronary artery calcium scoring for known CAD | 38.9 (34.1-43.7) | 43.1 (38.7-47.4) | 44.3 (40.3-48.4) | 62.1 (57.9-66.2) | 72.7 (49.6-95.7) |
| CT scan for emergency department evaluation of dizziness | 1198.1 (1183.1-1213.0) | 1070.6 (1056.4-1084.9) | 1070.0 (1056.6-1083.4) | 1138.4 (1126.2-1150.5) | 1217.3 (1207.2-1227.4) |
| Bleeding time test | 318.9 (285.0-352.8) | 251.1 (219.1-283.0) | 124.1 (107.4,-140.8) | 121.3 (99.6-143.1) | 107.2 (−101.9-316.2) |
| Preventive screen | 29 841.2 (29 431.5-30 250.9) | 28 106 (27 787.1-28 424.9) | 26 129.1 (25 884.9-26 373.3) | 24 786.3 (24 529.5-25 043.0) | 24 413.2 (24 391.8-24 434.7) |
| Cervical cancer screen in woman not at high risk with adequate prior screening | 2721.2 (2711.8-2730.6) | 2555.7 (2546.3-2565.2) | 2345.5 (2336.1-2354.9) | 2138.8 (2130.1-2147.4) | 1914.8 (1914.2-1915.4) |
| Annual ECG or cardiac screen in patient without symptoms or risk factors | 6453.8 (6073.4-6834.1) | 5681.4 (5386.9-5975.9) | 4121.0 (3895.7-4346.4) | 4609.1 (4373.7-4844.5) | 5062.8 (5049.5-5076.1) |
| DEXA screen for osteoporosis in woman aged <65 y or man aged <70y | 7.4 (5.5-9.2) | 5.5 (4.7-6.2) | 5.3 (4.1-6.5) | 3.1 (2.8-3.5) | 3.2 (−10.6-17.1) |
| Unnecessary colorectal cancer screen in adult aged 50-75 y | 11 057 (10 919.5-11 194.5) | 10 634.5 (10 541.5-10 727.4) | 9995.9 (9927.8-10 064.1) | 9589.2 (9510.8-9667.6) | 9593 (9587.2-9598.8) |
| Screen for vitamin D deficiency | 3702 (3658.2-3745.9) | 3435.3 (3369.9-3500.7) | 3659.2 (3606.1-3712.3) | 2962.6 (2906.7-3018.4) | 2639.9 (2636.9-2642.9) |
| Cardiac stress test or advanced imaging for patient without symptoms or risk factors | 5899.9 (5852.6-5947.2) | 5793.6 (5749.4-5837.9) | 6002.1 (5966.3-6037.9) | 5483.6 (5449.2-5518.0) | 5199.5 (5192.4-5206.6) |
| Preoperative test | 85 993.0 (85 450.1-86 536.0) | 82 330.5 (81 777.0-82 883.9) | 72 393.8 (71 883.3-72 904.3) | 71 365.4 (70 824.1-71 906.6) | 74 585.1 (74 502.6-74 667.6) |
| Preoperative laboratory study in patient without significant systemic illness before elective low-risk surgery | 79 184.9 (78 656.2-79 713.7) | 76 023.4 (75 476.6-76 570.2) | 66 718.8 (66 214.0-67 223.5) | 65 908.2 (65 372.0-66 444.3) | 69 127.0 (69 123.8-69 130.2) |
| Preoperative ECG, chest radiograph, or pulmonary function test in patient without significant systemic illness before low-risk surgery | 6635.3 (6512.3-6758.2) | 6155.3 (6070.6-6240) | 5509.5 (5434.4-5584.6) | 5277.0 (5203.8-5350.3) | 5286.7 (5278.0-5295.4) |
| Preoperative echocardiogram or stress test before low-risk or intermediate-risk noncardiac surgery | 114.3 (104.3-124.4) | 89.6 (83.9-95.3) | 92.6 (83.2-102.1) | 87.5 (82.6-92.4) | 85.0 (39.4-130.7) |
| Routine pulmonary function test before cardiac surgery | 58.5 (51.7- 65.4) | 62.2 (54 .6-69.7) | 72.9 (64.8-81.1) | 92.6 (83.0-102.3) | 86.4 (18.3-154.5) |
| Invasive procedure | 9888.5 (9704.1-10 072.9) | 12 593.5 (8 794.3, 16392 .7) | 12514.3 (12 256.1-12 772.5) | 12 468.0 (12 208.8-12 727.3) | 13 258.8 (12 879.8-13 637.8) |
| Renal artery revascularization | 1486.1 (1415.8-1556.4) | 1591.7 (1504.7-1678.7) | 1973.6 (1907.8-2039.5) | 1776.7 (1703.2-1850.3) | 1937.6 (1718.7-2156.5) |
| Arthroscopic lavage and debridement for knee osteoarthritis | 149.6 (143.0-156.2) | 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 | 2692.5 (2546.7-2838.3) | 5482.4 (1685.1-9279.8) | 5501.1 (5261.6-5740.6) | 5379.4 (5141.0-5617.7) | 5797.8 (5500.2-6095.4) |
| Coronary angiogram in patient without symptoms or risk factors | 5560.3 (5472.3-5648.4) | 5366.9 (5286.2-5447.7) | 4893.3 (4823.1-4963.6) | 5185.1 (5114.7-5255.5) | 5398.7 (5345.5-5451.9) |
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.