Which early disease detection tests are worth paying for?

Ranked on: proven benefit for the population offered the test, set against total cost — the test plus the expected follow-up cascade — and whether it is typically covered. A test with no outcome evidence cannot rank above C whatever it costs; one that failed its trial cannot rank above D.

1. 01

   ApoB and lipoprotein(a)

   GRADE A·EstablishedCheap, reproducible, and the treatment works

   ApoB costs little more than a standard lipid panel and identifies atherogenic-particle burden more accurately; lipoprotein(a) is a genetic risk factor measured once in a lifetime that no other test detects and that changes how aggressively ApoB should be lowered. Both feed treatments with randomised mortality evidence. The best value on the page, and the Lp(a) test most people have never had.

2. 02

   Coronary artery calcium scoring, intermediate risk

   GRADE A·EstablishedModest price; reclassifies; guides a proven treatment

   Typically paid out of pocket at a modest price, it reclassifies cardiovascular risk in intermediate-risk adults — a zero score argues against a statin, a high score for one — and the treatment it guides has outcome evidence. Low radiation; incidental findings are fewer than with whole-body imaging. The best-value test that usually is not covered.

3. 03

   Low-dose CT for heavy smokers

   GRADE A·EstablishedRandomised mortality benefit; often covered

   Annual low-dose CT in people with a heavy smoking history reduced lung-cancer mortality in randomised trials and is covered by many systems for that population. The follow-up cascade is real — false positives are common and overdiagnosis substantial — and it is priced into a benefit that still holds. Worth it in exactly the population studied.

4. 04

   Colorectal screening — colonoscopy, or stool-DNA / blood-based tests

   GRADE A·EstablishedProven, and mostly covered

   Colonoscopy on the guideline schedule finds and removes precursors with mortality evidence; stool-DNA and blood-based tests are less sensitive for precursors but proven enough to be approved and useful for people who will not have a colonoscopy. Typically covered in the recommended age range.

5. 05

   Mammography in the recommended range

   GRADE B·PromisingProven benefit, quantified harms, usually covered

   Randomised evidence of reduced breast-cancer mortality, with false positives and overdiagnosis that are measured rather than hidden. Covered in most systems within guideline ages; worth paying for outside them only with specific risk.

6. 06

   Targeted genetic testing with a strong family history

   GRADE B·PromisingChanges screening and sometimes treatment

   Testing for a specific gene where a particular cancer or condition runs strongly in the family — hereditary breast and ovarian cancer, Lynch syndrome, familial hypercholesterolaemia — changes screening intervals and sometimes leads to risk-reducing treatment. Moderate cost, often covered with the indication. Worth it for the family history; not for curiosity.

7. 07

   Full-skin examination

   GRADE B·PromisingCheap; finds the cancers sun exposure causes

   A dermatologist's or trained GP's full-skin check for anyone with significant sun exposure or a history of skin cancer. Low cost, low harm, and the earliest detection of melanoma is the one that changes survival most.

8. 08

   p-tau217 blood test, in cognitively normal adults

   GRADE C·EarlyAccurate, inexpensive, and changes nothing yet

   Approved for symptomatic people, where it replaces costlier PET. Ordered in a well adult it accurately identifies pathology years early — with no treatment that alters the course enough to justify knowing and a real psychological cost. Not worth paying for as a screen, yet.

9. 09

   'Comprehensive' panels of 100+ analytes

   GRADE C·EarlyA few useful markers buried in a subscription

   The valuable markers — ApoB, Lp(a), HbA1c, ferritin, vitamin D — are a small fraction of the panel and available individually for less; the rest generates findings without decisions and drives retests. The price buys the dashboard, not the medicine.

10. 10

    Multi-cancer early detection blood tests (Galleri)

    GRADE D·Insufficient or unsafeHigh price; misses most early cancers; trial missed

    Priced at several hundred per test, annually; detects about 17% of stage I cancers; the only randomised trial missed its primary endpoint; a false positive takes months and multiple scans to resolve. The cost of the cascade is the part of the price nobody quotes.

11. 11

    Whole-body MRI

    GRADE D·Insufficient or unsafeThe most expensive test in medicine once the cascade is counted

    Priced from several hundred to several thousand, with a critical or indeterminate finding in roughly a third of asymptomatic people, most of which has no follow-up guideline, and no evidence of benefit. The follow-up imaging, referrals and biopsies are unpriced and frequently uncovered. Opposed as a screen by radiology bodies.

12. 12

    Whole-genome sequencing and polygenic risk scores in healthy adults

    GRADE D·Insufficient or unsafeCost without a decision

    Sequencing a healthy adult yields mostly variants of uncertain significance; polygenic scores shift risk modestly and rarely change what is already advisable. The price buys data, not a decision.