This is a research letter from the Archives of Internal Medicine that received a good deal of press recently, examining exactly where in the health system we were wasting money.
They focused on the ambulatory setting, used the NAMCS/NHAMCS database, and evaluated for the activities identified in the "Good Stewardship Working Group" identified by consensus to be low-yield and unnecessary. They considered this to include antibiotics for afebrile/non-strep pharyngitis, routine EKGs, CT and MRI for uncomplicated low back pain, DEXA scans for young women, etc. And they found - and this is where the big story comes in - $6.7 billion in these consensus not-recommended activities.
Fortunately for our Internal Medicine and Family Medicine colleagues, they actually weren't ordering a lot of unnecessary tests - $175 million for low back pain and $527 million for DEXA are a lot of money, but still a drop in the bucket. The majority of the unnecessary activities, $5.8 billion of the total $6.7 billion, was writing for a brand-name statin (atorvastatin or rosuvastatin) instead of one of the generics.
Certainly just the tip of the iceberg. Drug reps are more than earning their salaries, apparently.
"'Top 5' Lists Top $5 Billion"