Three Cheaper Alternatives to Expensive Tests.

May 7, 2010 in Health Policy, Medicine by RangelMD

As Medicare and insurance companies continue to poor billions into expensive testing while Americans wonder why their health care costs are so high, kudos to Newsweek for high-lighting three cheap screening tests that are just as good as the expensive ones.

  1. SAGE testing for Alzheimer’s Dementia: Far too many patients are diagnosed in the advanced stages of dementia after they are no longer able to hide their memory loss from their family and physicians and their cognitive decline becomes too obvious to ignore. At this stage, they are generally beyond effective treatment since their lost mental faculties are not recoverable. Paper tests for dementia such as the “mini-mental stateĀ  exam” (MMSE) or the “Mini-cog” require a lot of interaction between the health provider and the patient and so are less likely to be used by busy physicians. Another paper test called the Short Portable Mental Status Questionnaire can be done in just 5 minutes but its sensitivity in detecting mild, early dementia is only 55%. The SAGE test (Self-Administered Geocognitive Examination) can be done by the patient while they wait and has a sensitivity (detecting mild dementia) of 80% and a specificity (ruling out mild dementia) of 95%. In contrast, laboratory testing and neuroimaging (CAT scan or MRI) have extremely low yield rates – i.e. they are either completely normal or don’t show a treatable cause for the dementia – even in cases of moderate to advanced memory and cognitive decline.
  2. The 3 Minute Mental Health Questionnaire (M3): Depression is screened for using the PHQ-9 questionnaire but it doesn’t evaluate for other mental health conditions such as anxiety, bipolar depression, PTSD, psychosis, etc. This is where the M3 comes in.
  3. Predicting Diabetic Risk ages 45-64: Type II diabetes usually develops asymptotically over years (10 +) before manifesting. A recent study has found that a simple non-lab evaluation based on family history, weight, weight, waste size, resting heart rate, and a few other factors can predict the chances of developing diabetes within the next 10 years.

The true value of these tests comes from the fact that they are quick and easy to perform and do not require any expensive lab testing or imaging and can be very useful in either initiating early treatment and/or raising patient and provider awareness of this increased risks of diabetes, psychiatric disorders, or dementia for a particular patient.

Of course, neither Medicare nor any health insurance will pay specifically for these tests (no kidding) but they will shell out thousands for neuroimaging that usually has a very low diagnostic yield when applied “shotgun style” for every dementia patient.

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