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Screening

Is a more expensive health checkup package better?

The thing that rises most reliably with the price is the radiation dose. Whether anything else does has not been shown.

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2 cited
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Answer

What scales dependably with price is radiation. In an analysis of 190 comprehensive health examination programmes at ten Seoul university hospitals, 132 (69.5 percent) included computed tomography and the average effective dose ran from 3.62 mSv for an intensive disease-specific programme to 11.12 mSv for an intensive cancer programme, 18.14 mSv for a premium programme and 24.08 mSv for an overnight programme — between 3.6 and 24 times the annual public dose limit — with cost correlating with dose at r = 0.812, while the 2019 Cochrane review of general health checks found no effect on total mortality across 11 randomised trials and 233,298 participants (RR 1.00, 95% CI 0.97 to 1.03, high-certainty evidence).

Key takeaways

  • 190 comprehensive health examination programmes at ten Seoul university hospitals were analysed; 132 (69.5 percent) included computed tomography, averaging 1.4 scans.
  • Average effective dose: 3.62 mSv (intensive, disease-specific), 11.12 mSv (intensive cancer), 18.14 mSv (premium), 24.08 mSv (overnight).
  • Those doses are 3.6 to 24 times the annual dose limit for a member of the public, delivered to people with no symptoms.
  • Programme cost correlated with effective radiation dose at r = 0.812.
  • The 2019 Cochrane review found general health checks had no effect on total mortality: RR 1.00 (95% CI 0.97 to 1.03) across 11 trials and 233,298 participants, rated high-certainty.
  • The same review found no effect on cancer mortality (RR 1.01) and probably none on cardiovascular mortality (RR 1.05).
  • No study has shown that a higher-priced package produces better health outcomes than a lower-priced one.

The premium tier of a Korean comprehensive checkup is sold on the reasonable-sounding premise that more testing finds more. The published analysis of what is actually inside those tiers supports a narrower statement: more testing delivers more radiation, and the correlation is tight.

What the price buys

r = 0.812

correlation between the cost of a Korean comprehensive checkup programme and its effective radiation dose, across 190 programmes at ten Seoul university hospitalsLee YK, Environmental Health and Toxicology, 2016
Average effective dose by programme tier
ProgrammeEffective dose
Intensive, disease-specific3.62 mSv
Intensive cancer11.12 mSv
Premium18.14 mSv
Overnight24.08 mSv

The reference point is that the annual dose limit for a member of the public is 1 mSv. An overnight package delivers roughly twenty-four years of that limit in a day, to somebody who came in feeling well.

What has not been shown to rise with it

The Cochrane review of general health checks pooled 11 randomised trials and 233,298 participants and found no effect on total mortality — risk ratio 1.00, with a confidence interval from 0.97 to 1.03, rated high-certainty evidence. Cancer mortality was unchanged (RR 1.01) and cardiovascular mortality probably unchanged (RR 1.05).

How to read a package list

The useful question is not which tier to buy but which named tests are in it and what each one has been shown to do. That turns a price comparison into an evidence comparison, and the two do not run in the same direction.

One more detail from the same analysis makes the point sharply: programmes with the same stated purpose differed in dose by up to 2.1 times between hospitals. Even within a tier, what is being bought is not standardised.

Sources

  1. 1

    Lee YK

    Level of radiation dose in university hospital noninsured private health screening programs in Korea

    Environmental Health and Toxicology 2016;31:e2016007

    doi:10.5620/eht.e2016007 · PMID:27032387

    https://doi.org/10.5620/eht.e2016007
  2. 2

    Krogsbøll LT, Jørgensen KJ, Gøtzsche PC

    General health checks in adults for reducing morbidity and mortality from disease

    Cochrane Database of Systematic Reviews 2019;1:CD009009

    doi:10.1002/14651858.cd009009.pub3 · PMID:30699470

    https://doi.org/10.1002/14651858.cd009009.pub3