Health economics
The test is never the expensive part.
Medicare pays between $2.70 and $39.26 for every blood test in this catalogue. What a result is worth depends on two other things: what you would do about it, and how much of the hazard curve is actually causal.
- $8.95median Medicare fee for the 34 priced tests (CLFS, October 2026)
- 3.0 yrlargest expected gain for an average 50-year-old: Apolipoprotein B (ApoB), after discounting for causality
- 0.04%the most of a hazard curve that needs to be causal for any test here to pay for itself at $100,000 per life-year
- $0–$5,850annual cost of the best catalogued intervention, from a diet change to a PCSK9 inhibitor
What the table says
Each row takes one biomarker, an average US adult at 50, and the best lifestyle change and the best drug in the intervention catalogue for that marker. The catalogued effect is applied to the population mean and read off the mortality hazard curve: that gives the hazard ratio for the move and the undiscounted life-years it would add if the whole curve were causal.
It is not. Age- and sex-adjusted associations overstate what changing a marker achieves. So each marker carries a causal fraction κ by evidence status: 0.8 where Mendelian randomisation supports it, 0.5 where trials move the marker, 0.25 for strong observational evidence, 0.1 otherwise. These are judgements, following the priors in our value-of-information programme, and the "if fully causal" number is shown beside each adjusted one.
The break-even column asks the reverse question: at $100,000 per life-year, how much of the curve would have to be causal for the test fee alone to be worth paying? For every priced test the answer is under 0.05%. The fee is not the decision.
| Biomarker | Medicare fee | Best lifestyle change · effect · hazard · years gained × κ · cost | Best drug · effect · hazard · years gained × κ · cost |
|---|---|---|---|
| Apolipoprotein B (ApoB) rct supported · κ 0.50 |
$21.09 82172 |
Very low saturated fat diet coupled with viscous dietary fibers -20% · hazard ×0.72 · +1.7 yr (3.4 if fully causal) · $0 |
PCSK9 monoclonal antibodies (Evolocumab / Alirocumab) -50% · hazard ×0.44 · +3.0 yr (5.9 if fully causal) · $5,850 a year · ≈ $59,055 per life-year |
| Serum Triglycerides mendelian randomization · κ 0.80 |
$5.74 84478 |
Carbohydrate restriction and ketogenic / low-glycemic dietary protocol -42% · hazard ×0.74 · +2.5 yr (3.2 if fully causal) · $0 |
Icosapent ethyl (Purified EPA 4g/day) -5% · hazard ×0.97 · +0.3 yr (0.4 if fully causal) · not costed |
| Lipoprotein(a) [Lp(a)] mendelian randomization · κ 0.80 |
$14.32 83695 |
none catalogued with a favourable effect | Antisense oligonucleotide / siRNA inhibitors (Pelacarsen / Olpasiran) -82% · hazard ×0.73 · +2.1 yr (2.7 if fully causal) · not costed |
| Systolic Blood Pressure (SBP) rct supported · κ 0.50 |
no lab fee | DASH Dietary Pattern combined with sodium reduction (<1500 mg/day) -14 mmHg · hazard ×0.71 · +1.2 yr (2.5 if fully causal) · $0 |
First-line antihypertensive dual combination (ACEi/ARB + DHP-CCB or Thiazide) -25 mmHg · hazard ×0.55 · +1.2 yr (2.5 if fully causal) · $30 a year · ≈ $730 per life-year |
| LDL Cholesterol rct supported · κ 0.50 |
$10.50 83721 |
Portfolio Diet (Plant sterols, soy protein, viscous fiber, almonds) -25% · hazard ×0.87 · +0.7 yr (1.5 if fully causal) · $0 |
High-intensity statins plus Ezetimibe 10 mg combination therapy -62% · hazard ×0.71 · +1.1 yr (2.2 if fully causal) · $13 a year · ≈ $349 per life-year |
| Serum Albumin strong observational · κ 0.25 |
$4.95 82040 |
Optimal dietary protein intake (1.2-1.6 g/kg/day with essential amino acids) +0.6 g · hazard ×0.47 · +1.1 yr (4.3 if fully causal) · $0 |
Resolution of systemic inflammation via anti-inflammatory therapy +0.8 g · hazard ×0.36 · +1.1 yr (4.3 if fully causal) · not costed |
| Estimated Glomerular Filtration Rate (eGFR) rct supported · κ 0.50 |
$5.12 82565 |
none catalogued with a favourable effect | SGLT2 inhibitors (Empagliflozin / Canagliflozin) +40% · hazard ×0.86 · +1.1 yr (2.1 if fully causal) · $2,364 a year · ≈ $66,425 per life-year |
| Fibrinogen strong observational · κ 0.25 |
$9.72 85384 |
Cessation of cigarette smoking -20% · hazard ×0.68 · +1.0 yr (4.1 if fully causal) · $0 |
Fibrate therapy (Fenofibrate 145-200 mg/day) -16% · hazard ×0.73 · +0.8 yr (3.3 if fully causal) · not costed |
| Serum 25-Hydroxyvitamin D strong observational · κ 0.25 |
$29.60 82306 |
Oral Vitamin D3 (Cholecalciferol 2000-5000 IU/day) +35 ng/mL · hazard ×0.69 · +1.0 yr (4.0 if fully causal) · $25 a year · ≈ $754 per life-year |
none catalogued with a favourable effect |
| Alkaline Phosphatase (ALP) strong observational · κ 0.25 |
$5.18 84075 |
Optimization of Vitamin D and dietary Calcium homeostasis -20% · hazard ×0.76 · +0.7 yr (2.9 if fully causal) · $0 |
Antiresorptive bisphosphonates (Alendronate / Zoledronic acid) in bone turnover / Paget's disease -58% · hazard ×0.46 · +1.0 yr (4.0 if fully causal) · not costed |
| Fasting Plasma Glucose mendelian randomization · κ 0.80 |
$3.93 82947 |
Postprandial walking and structured resistance training -22 mg/dL · hazard ×0.90 · +0.9 yr (1.2 if fully causal) · $0 |
Metformin therapy (500-2000 mg/day) -40 mg/dL · hazard ×0.99 · +0.9 yr (1.2 if fully causal) · $40 a year · ≈ $1,289 per life-year |
| Blood Urea Nitrogen (BUN) strong observational · κ 0.25 |
$3.95 84520 |
Structured dietary protein moderation (0.8-1.0 g/kg body weight) in CKD -30% · hazard ×0.72 · +0.9 yr (3.4 if fully causal) · $0 |
Guideline-directed neurohormonal blockade in heart failure (Beta-blockers, ACEi) -20% · hazard ×0.80 · +0.6 yr (2.4 if fully causal) · not costed |
| Maximal Grip Strength strong observational · κ 0.25 |
no lab fee | Progressive whole-body resistance training (Heavy compound lifting) +25% · hazard ×0.73 · +0.8 yr (3.3 if fully causal) · $0 |
none catalogued with a favourable effect |
| Cardiorespiratory Fitness (VO2 Max) strong observational · κ 0.25 |
no lab fee | High-Intensity Interval Training (HIIT 4x4 min @ 90% HRmax) +17% · hazard ×0.75 · +0.8 yr (3.0 if fully causal) · $0 |
none catalogued with a favourable effect |
| Fasting Serum Insulin strong observational · κ 0.25 |
$11.43 83525 |
Therapeutic intermittent fasting and prolonged fasting (16:8 to 24hr) -45% · hazard ×0.78 · +0.7 yr (2.7 if fully causal) · $0 |
SGLT2 inhibitors (Empagliflozin / Dapagliflozin) -22% · hazard ×0.88 · +0.3 yr (1.3 if fully causal) · $2,364 a year · ≈ $212,543 per life-year |
| Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) strong observational · κ 0.25 |
$15.36 83525 + 82947 |
10% Total Body Weight Loss through lifestyle modification -45% · hazard ×0.81 · +0.6 yr (2.2 if fully causal) · $782 a year · ≈ $42,244 per life-year |
GLP-1 / GIP receptor agonists (Tirzepatide / Semaglutide) -52% · hazard ×0.78 · +0.6 yr (2.6 if fully causal) · $4,188 a year · ≈ $194,048 per life-year |
| High-Sensitivity C-Reactive Protein (hs-CRP) rct supported · κ 0.50 |
$12.95 86141 |
Mediterranean Diet rich in extra virgin olive oil and nuts -28% · hazard ×0.94 · +0.3 yr (0.7 if fully causal) · $0 |
Statin therapy (Atorvastatin 40-80 mg or Rosuvastatin 20 mg) -44% · hazard ×0.89 · +0.6 yr (1.3 if fully causal) · $13 a year · ≈ $616 per life-year |
| Aspartate Aminotransferase (AST) strong observational · κ 0.25 |
$5.18 84450 |
Ethanol abstinence in alcohol-associated liver disease -65% · hazard ×0.58 · +0.6 yr (2.3 if fully causal) · $0 |
none catalogued with a favourable effect |
| Serum Cystatin C strong observational · κ 0.25 |
$18.52 82610 |
Anti-inflammatory Mediterranean lifestyle and exercise -14% · hazard ×0.82 · +0.5 yr (2.1 if fully causal) · $0 |
SGLT2 inhibitors (Dapagliflozin / Empagliflozin) -28% · hazard ×0.68 · +0.6 yr (2.2 if fully causal) · $2,364 a year · ≈ $126,804 per life-year |
| Interleukin-6 (IL-6) mendelian randomization · κ 0.80 |
$17.27 83520 |
Structured resistance and moderate aerobic training -22% · hazard ×0.99 · +0.1 yr (0.1 if fully causal) · $0 |
Anti-IL-6 receptor monoclonal antibody (Tocilizumab) -70% · hazard ×0.94 · +0.5 yr (0.7 if fully causal) · not costed |
| Gamma-Glutamyl Transferase (GGT) strong observational · κ 0.25 |
$7.20 82977 |
Complete alcohol abstinence in heavy drinkers -55% · hazard ×0.81 · +0.5 yr (2.1 if fully causal) · $0 |
none catalogued with a favourable effect |
| Neutrophil-to-Lymphocyte Ratio (NLR) strong observational · κ 0.25 |
$7.77 85025 |
Aerobic endurance training and cardiovascular conditioning -22% · hazard ×0.83 · +0.5 yr (2.0 if fully causal) · $0 |
none catalogued with a favourable effect |
| Serum Phosphate strong observational · κ 0.25 |
$4.74 84100 |
Strict elimination of inorganic phosphate food additives and dark sodas -1.2 mg/dL · hazard ×0.67 · +0.4 yr (1.6 if fully causal) · not costed |
Non-calcium phosphate binders (Sevelamer carbonate / Lanthanum) -2.5 mg/dL · hazard ×0.54 · +0.4 yr (1.6 if fully causal) · not costed |
| Erythrocyte Sedimentation Rate (ESR) observational · κ 0.10 |
$2.70 85652 |
Anti-inflammatory Mediterranean dietary protocol -22% · hazard ×0.87 · +0.1 yr (1.5 if fully causal) · $0 |
Glucocorticoids and DMARD anti-inflammatory therapy in active inflammatory disease -55% · hazard ×0.71 · +0.4 yr (3.6 if fully causal) · not costed |
| Serum Uric Acid strong observational · κ 0.25 |
$4.52 84550 |
Vitamin C supplementation (500-1000 mg/day) -1 mg/dL · hazard ×0.86 · +0.4 yr (1.4 if fully causal) · not costed |
Xanthine oxidase inhibitors (Allopurinol 100-300 mg / Febuxostat 40-80 mg) -45% · hazard ×0.70 · +0.4 yr (1.4 if fully causal) · $20 a year · ≈ $1,685 per life-year |
| High-Sensitivity Cardiac Troponin T (hs-cTnT) strong observational · κ 0.25 |
$12.47 84484 |
Intensive blood pressure reduction and left ventricular hypertrophy regression -18% · hazard ×0.92 · +0.2 yr (0.9 if fully causal) · $30 a year · ≈ $4,112 per life-year |
Long-term Cardioprotective Beta-Blockers and ACEi/ARB in structural heart disease -25% · hazard ×0.89 · +0.3 yr (1.3 if fully causal) · $30 a year · ≈ $2,879 per life-year |
| Glycated Hemoglobin (HbA1c) rct supported · κ 0.50 |
$9.71 83036 |
Combined aerobic and resistance training (3x/week) -0.70 %-points · hazard ×0.97 · +0.3 yr (0.6 if fully causal) · $0 |
none catalogued with a favourable effect |
| Red Cell Distribution Width (RDW) strong observational · κ 0.25 |
$6.47 85027 |
Correction of micronutrient deficiencies (Iron, Vitamin B12, Folate) -2.25 %-points · hazard ×0.91 · +0.3 yr (1.1 if fully causal) · not costed |
none catalogued with a favourable effect |
| N-Terminal Pro-B-Type Natriuretic Peptide (NT-proBNP) strong observational · κ 0.25 |
$39.26 83880 |
Dietary sodium restriction (<2000 mg/day) and structured cardiac rehabilitation -22% · hazard ×0.93 · +0.2 yr (0.7 if fully causal) · $0 |
SGLT2 inhibitors (Empagliflozin / Dapagliflozin) in Heart Failure (HFrEF/HFpEF) -28% · hazard ×0.92 · +0.2 yr (0.9 if fully causal) · $2,364 a year · ≈ $312,814 per life-year |
| Urine Albumin-to-Creatinine Ratio (uACR) strong observational · κ 0.25 |
$10.96 82043 + 82570 |
none catalogued with a favourable effect | ACE inhibitors / ARBs titrated to maximally tolerated doses -42% · hazard ×0.92 · +0.2 yr (0.9 if fully causal) · $30 a year · ≈ $4,186 per life-year |
| Tumor Necrosis Factor-alpha (TNF-alpha) strong observational · κ 0.25 |
$17.27 83520 |
Plant-based polyphenol-rich dietary intervention -22% · hazard ×0.99 · +0.0 yr (0.1 if fully causal) · $0 |
TNF inhibitors (Infliximab / Adalimumab / Etanercept) -72% · hazard ×0.95 · +0.1 yr (0.6 if fully causal) · not costed |
| Apolipoprotein A1 (ApoA1) observational · κ 0.10 |
$21.09 82172 |
Aerobic endurance training and vigorous physical activity +13% · hazard ×0.87 · +0.1 yr (1.4 if fully causal) · $0 |
Niacin therapy (Extended-release 1000-2000 mg/day) +20% · hazard ×0.81 · +0.1 yr (1.4 if fully causal) · not costed |
| Urinary Creatinine Concentration observational · κ 0.10 |
$5.18 82570 |
Creatine monohydrate supplementation (5g/day) +30% · hazard ×0.86 · +0.1 yr (1.3 if fully causal) · not costed |
none catalogued with a favourable effect |
| HDL Cholesterol observational · κ 0.10 |
$8.19 83718 |
Vigorous aerobic endurance and high-intensity interval exercise +13% · hazard ×0.95 · +0.1 yr (0.5 if fully causal) · $0 |
none catalogued with a favourable effect |
| Serum Ferritin observational · κ 0.10 |
$13.63 82728 |
Dietary restriction of heme iron and red meat intake -25% · hazard ×0.98 · +0.0 yr (0.3 if fully causal) · $0 |
none catalogued with a favourable effect |
| Total Cholesterol observational · κ 0.10 |
$4.35 82465 |
Dietary soluble viscous fiber (Beta-glucan / Psyllium 10-15g/day) -8% · hazard ×0.99 · +0.0 yr (0.1 if fully causal) · $0 |
none catalogued with a favourable effect |
| Alanine Aminotransferase (ALT) observational · κ 0.10 |
$5.30 84460 |
Daily filtered black coffee consumption (2-3 cups/day) -20% · hazard ×1.00 · +0.0 yr (0.0 if fully causal) · $0 |
none catalogued with a favourable effect |
Medicare fee: CMS Clinical Laboratory Fee Schedule, CY2026 Q4 public use file, national rate for the CPT code shown; add $9.34 for the blood draw (36415). Years: undiscounted life-years for a US adult at age 50 at the population mean, moved by the catalogued effect, using the catalogue's hazard curve and CDC 2022 life tables. Cost per life-year: annual cost × 30 years of therapy ÷ κ-adjusted years, indicative only. Catalogued effects come from the trial populations named in the catalogue, which are often patients, not the general population. Break-even causal fraction for the test fee at $100,000 per life-year is below 0.05% for every priced row. Hover an intervention for its cost source.
The cost that matters
Set the test fee against the thing the result leads to. A year of the intervention ranges over four orders of magnitude, and the cheapest options sit at the top of the table.
- $0Diet, exercise, sleep, alcohol and smoking changesno direct medical cost; time and food are not valued here
- $13Generic atorvastatin 20 mg, dailyNADAC ≈ $0.03–0.04 per tablet, June 2026
- $20Generic allopurinol 300 mg, dailyNADAC ≈ $0.056 per tablet, July 2026
- $30Generic lisinopril + amlodipine, dailyNADAC ≈ $0.015–0.05 per tablet, June 2026
- $40Generic metformin ER 500 mg, twice dailyNADAC ≈ $0.055 per tablet, June 2026
- $782Medicare Diabetes Prevention Program, one yearmaximum CY2026 payment: 22 sessions at $27 plus weight-loss milestones
- $2,364Empagliflozin (Jardiance)2026 Medicare negotiated price, $197 per 30 days; $573 list
- $4,188Semaglutide (Wegovy / Ozempic), cashmanufacturer cash price $349 per month, from November 2025
- $5,850Evolocumab (Repatha)list price after the 2019 cut; 2026 Part D per-syringe pricing implies about $7,300
Three patterns fall out. First, where a generic drug moves a marker with trial support, the arithmetic is lopsided: a $10.50 LDL test and $13 a year of atorvastatin against an expected year of life. Second, the new agents that move kidney and metabolic markers most, SGLT2 and GLP-1 drugs, cost 100 to 300 times the generics, and their indicative cost per life-year lands near conventional thresholds. Third, for the inflammatory and nutritional markers, the best catalogued move is free, and the open question is adherence, not price.
What published analyses say
Full cost-effectiveness models of screening for single markers reach the same shape of answer. hs-CRP screening to target statins was estimated at $42,600 per QALY for 65-year-old men and $207,300 for 35-year-old women: same test, different prior risk. An HbA1c cut-off of 5.7% for diabetes screening came in under $50,000 per QALY in a CDC model, and the broadened US screening recommendation at about $29,000 per QALY. Combined cholesterol screening and treatment has been put at roughly $34,000 per QALY. In each case the fee of the test is a rounding error; the result turns on who is tested and what treatment follows.
What this is not
This page is a screen, not a cost-effectiveness analysis. It does not discount, quality-adjust, model measurement error, treat-all versus test-and-treat, adherence, side effects, or the cost of the downstream care a result triggers. The catalogued intervention effects are typical values from their source trials, applied to an average adult who may not resemble those trial participants. A journal-grade decision model with probabilistic sensitivity analysis and value-of-information results is specified and under way; see Collaborate if you hold cost or outcome data that would strengthen it.
Sources
Test fees: CMS, Clinical Laboratory Fee Schedule CY2026 Q4 public use file, retrieved 14 October 2026. Drug acquisition costs: CMS NADAC as republished by ndclist.com and hellopharmacist.com, June–July 2026. Empagliflozin: CMS Maximum Fair Price for 2026, via the Maryland Prescription Drug Affordability Board review. Semaglutide: Novo Nordisk cash-price announcement, November 2025. Evolocumab: Amgen list-price reduction, 2018. Diabetes Prevention Program: CMS MDPP CY2026 payment fact sheet. Published analyses: CRP screening (Lee et al.), HbA1c cut-offs (CDC Markov model), broadened diabetes screening (ICER $29,337/QALY), cholesterol screening ($33,800/QALY); see Evidence for the catalogue's own validation.