Researchers hypothesized that a patient's willingness to undergo diagnostic testing is influenced by the potential benefit, risk, and personal cost. Patient preferences for diagnostic testing differed significantly across levels of risk, benefit, and cost of diagnostic testing, but cost was the strongest and most consistent factor associated with decreased desire for testing. The study was published in Academic Emergency Medicine (AEM), a journal of the Society for Academic Emergency Medicine (SAEM).

The emergencydepartment-based study, by Porath, et al, utilized a copay to "penalize" for the test. The results suggest that a credit for foregoing the test (similar to a safe driver discount) might be an interesting direction for future research. With patients having a growing personal contribution to health care, the findings support the need for further study to determine how best to implement financial considerations to alter testing behavior.

Researchers conducted a cross sectional survey among emergency department patients for diagnostic testing in 2 hypothetical scenarios: chest pain (CP) and mild traumatic brain injury (mTBI). Each scenario defined specific risks, benefits, and costs of testing. The odds of a participant desiring diagnostic testing were calculated using a series of nested multivariable logistic regression models.

Participants opted for diagnostic testing 68.2% of the time, including 69.7% of CP and 66.7% of all mTBI scenarios. In the chest pain scenario, 81% of participants desired free testing versus 59% when it was associated with a $100 copay (difference: 22%; 95% CI 16 ? 28%). Similarly, in the mTBI scenario, 73% of adult participants desired free testing versus 56% when charged a $100 copayment (difference 17%; 95% CI 11 ? 24%).

Benefit and risk had mixed effects across the scenarios. In fully adjusted models, the association between cost and desire for testing persisted in the CP (OR 0.33; 95% CI 0.23 ? 0.47) and adult mTBI (OR 0.47; 95% 0.33 ? 0.67) scenarios.

In this emergency department based study, patient preferences for diagnostic testing differed significantly across levels of risk, benefit, and cost of diagnostic testing. Cost was the strongest and most consistent factor associated with decreased desire for testing.

This study highlights the importance patients may place on the cost of low-value diagnostic testing. Implementing these findings requires careful consideration, as discussing cost in this context may have unintended effects on physician trust and runs the risk of disproportionately influencing decision-making in uninsured patients. Nonetheless, it is important for physicians to recognize the importance of cost as a driver of patient decision-making in low-value diagnostic testing.