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More Justification Needed for Choosing Wisely Selections

Of the 25 societies evaluated, 60 percent had at least one service included because of higher costs

WEDNESDAY, April 9, 2014 (HealthDay News) -- Most services included in specialty medical societies' Top 5 lists for the Choosing Wisely campaign are based on evidence demonstrating equivalent but not superior benefit, with higher risk or higher costs compared to other options, according to a research letter published in the April 9 issue of the Journal of the American Medical Association.

Catherine Gliwa and Steven D. Pearson, M.D., both from the National Institutes of Health in Bethesda, Md., analyzed the evidentiary rationales provided by specialty societies in order to assess how benefits, risks, and costs affect selection of a service for the Top 5 lists.

The researchers found that, of the 135 services, 36 percent were for patient diagnosis, prognosis, or monitoring; 34 percent for patient treatment; and 30 percent for population screening. The vast majority (95 percent) of services had identical initial evidence categorization. Three-quarters of services were included based on justification that adequate evidence demonstrated no additional benefit, with higher risk, higher cost, or both, compared with other options. Nearly half of the services (49 percent) were considered because of greater risk to patients, 24 percent because of higher costs, and 16 percent because of both greater risk and higher cost. Sixty percent of the 25 specialty societies had at least one service which was included in part because of higher costs.

"Our data show that the issue of cost was almost always raised in the context of a service being judged as good as other options but more expensive. We believe that specialty societies should seek greater opportunities to include within their Top 5 lists services that offer only small incremental benefits at much higher prices," the authors write. "Specialty societies can enhance trust in the Choosing Wisely campaign by defining more clearly the types of potentially wasteful medical care they seek to eliminate, and by providing a clear evidentiary justification for the selection of each service."

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