Most Preprocedural Urinalyses Represent Low-Value Care
Between six and 28 percent of preprocedural urinalyses that were not indicated were followed by an antibiotic prescription
THURSDAY, Aug. 12, 2021 (HealthDay News) -- Preprocedural urinalyses are common but largely not indicated, according to a research letter published online Aug. 2 in JAMA Internal Medicine.
Erica S. Shenoy, M.D., Ph.D., from Massachusetts General Hospital in Boston, and colleagues used 2007 to 2017 IBM Watson MarketScan commercial and Medicare claims to analyze use of preprocedural urinalyses for 14 procedure-group families.
The researchers found that among 13,169,656 procedures, 25 percent were preceded by urinalyses within 30 days, with variance across procedure categories. For the majority of procedures for which urinalyses were obtained (89 percent), urinalysis was not indicated. These urinalyses had a mean price per test of $17. Between 5.8 and 28 percent of the nonindicated urinalyses were followed by an antibiotic prescription, with antibiotic spending ranging from $20 to $65 per course. Total spending on inappropriate urinalyses was estimated to be $48,675,408, while total spending on antibiotics following inappropriate urinalyses was an additional $4,854,109.
"While several successful approaches to reducing both screening for asymptomatic bacteriuria as well as its treatment have been reported -- including among preoperative patients -- prevailing practice patterns remain entrenched," the authors write. "Insurers and employers also have a potentially influential role in reducing such low-value care. Through benefit design and payment policies, insurers may target wasteful spending and combat antibiotic resistance."
One author disclosed financial ties to the pharmaceutical industry.