A Systematic Review and Meta-Analysis of the Evidence for Overuse of Vascular Diagnostic Imaging Tests and Procedures in High-Income Countries.
Aidan M Kirkham, Emma E Sypes, Chen Chen Xu et al.
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In 30 seconds
This systematic review and meta-analysis assessed overuse of vascular diagnostic imaging tests and procedures in high-income countries. Fourteen studies involving 16,706,904 patients examined two imaging tests and eight procedures. Pooled cumulative incidence of overuse was 19% (95% CI = 10-30%) for carotid imaging and 46% (95% CI = 43-48%) for venous duplex. Estimates were also high for renal artery angioplasty and inferior vena cava filter placement, though certainty was low. Overuse was associated with increased health-care costs in every study assessing costs; the authors caution that important limitations warrant confirmation of these findings.
Key findings
- Pooled overuse incidence was 19% (95% CI = 10-30%) for carotid imaging and 46% (95% CI = 43-48%) for venous duplex, with moderate certainty.
- Overuse incidence was 92% (95% CI = 85-97%) for renal artery angioplasty and 72% (95% CI = 0-100%) for inferior vena cava filter placement; certainty was low.
- Overuse was associated with increased health-care costs in all studies that examined this outcome.
Why it matters
The review suggests that potentially unnecessary vascular testing and procedures occur across high-income countries and may add to health-care costs. The wide variation in estimates and differing certainty across interventions underscore the need to interpret pooled rates cautiously. Better evidence on where overuse occurs and its consequences could inform efforts to improve the appropriateness of vascular care.
What to keep in mind
Only 14 studies were included, and the authors report important limitations in the evidence; certainty was low for several procedure estimates.