Table 3. Cost of Low-Value Health Services Delivered by Veterans Health Administration (VA) Facilities and in VA Community Care Programs in Fiscal Year 2018.
| Low-value health services by domain | Costa | |
|---|---|---|
| Millions of dollars | Proportion of overall cost, % | |
| Cancer screening | ||
| PSA testing for men aged ≥75 y | 7.9 | 3.8 |
| Colorectal cancer screening for adults aged ≥75 y | 4.3 | 2.1 |
| Cervical cancer screening for women aged ≥65 y | 0.3 | 0.1 |
| Cancer screening for patients with CKD receiving dialysis | 0.6 | 0.3 |
| Total | 13.0 | 6.3 |
| Imaging | ||
| Imaging for patients with nonspecific low back pain | 25.4 | 12.3 |
| Screening for carotid artery disease in asymptomatic adults | 19.6 | 9.5 |
| Head imaging for uncomplicated headache | 12.7 | 6.2 |
| Head imaging for syncope | 3.1 | 1.5 |
| CT of the sinuses for uncomplicated acute rhinosinusitis | 1.5 | 0.7 |
| Screening for carotid artery disease for syncope | 1.4 | 0.7 |
| Imaging for diagnosis of plantar fasciitis | 0.4 | 0.2 |
| EEG for headaches | 0.6 | 0.3 |
| Total | 64.7 | 31.4 |
| Preoperative testing | ||
| Chest radiography | 8.7 | 4.2 |
| Echocardiography | 7.9 | 3.8 |
| Stress test | 7.5 | 3.7 |
| Pulmonary function test | 1.0 | 0.5 |
| Total | 25.1 | 12.2 |
| Diagnostic and preventive testing | ||
| PTH measurement for patients with stage 1-3 CKD | 4.5 | 2.2 |
| 1,25-Dihydroxyvitamin D testing in the absence of hypercalcemia or decreased kidney function | 1.4 | 0.7 |
| Total or free T3 level testing for patients with hypothyroidism | 0.5 | 0.3 |
| Homocysteine testing for cardiovascular disease | 0.1 | 0.1 |
| BMD testing at frequent intervals | 0.4 | 0.2 |
| Hypercoagulability testing for patients with deep vein thrombosis | 0.1 | <0.001 |
| Total | 7.0 | 3.4 |
| Other procedures | ||
| Spinal injection for low back pain | 43.9 | 21.4 |
| Arthroscopic surgery for knee osteoarthritis | 3.0 | 1.4 |
| Total | 46.9 | 22.8 |
| Cardiovascular testing and procedures | ||
| Stress testing for stable coronary disease | 4.0 | 2.0 |
| PCI with balloon angioplasty or stent placement for stable coronary disease | 36.8 | 17.9 |
| IVC filters to prevent pulmonary embolism | 6.4 | 3.1 |
| Renal artery angioplasty or stenting | 1.8 | 0.9 |
| Carotid endarterectomy in asymptomatic patients | <0.001 | <0.001 |
| Total | 49.0 | 23.8 |
| Grand total | 205.8 | 100 |
Abbreviations: BMD, bone mineral density; CKD, chronic kidney disease; CT, computed tomography; EEG, electroencephalogram; IVC, inferior vena cava; PCI, percutaneous coronary intervention; PSA, prostate-specific antigen; PTH, parathyroid hormone; T3, triiodothyronine.
Cost is derived from the use of low-value health services by specific criteria and is based on standardized cost estimates for each low-value service generated by the VA Health Economics Resource Center. For each low-value service, we applied the cost directly attributable to the Current Procedural Terminology code recorded for the service and the costs attributable to any facility fees or other necessary ancillary tasks, such as venipuncture for a low-value blood test or sedation for a low-value procedure.