Evidence of overtesting for vitamin D in Australia: an analysis of 4.5 years of Medicare Benefits Schedule (MBS) data
BMJ Open 2013;3:e002955 doi:10.1136/bmjopen-2013-002955
Kellie Bilinski1, Steve Boyages2
1Westmead Breast Cancer Institute, Westmead Hospital, Westmead NSW and The University of Sydney, Western Clinical School, Sydney New South Wales, Australia
2Department of Endocrinology, Westmead Hospital, The University of Sydney, eHealth NSW Initiative, NSW Health, Westmead, New South Wales, Australia
Dr Kellie Bilinski; Kellie.Bilinski at bci.org.au
Objective To comprehensively examine pathology test utilisation of 25-hydroxyvitamin D (25(OH)D) testing in each state of Australia to determine the cost impact and value and to add evidence to enable the development of vitamin D testing guidelines.
Design Longitudinal analysis of all 25(OH)D pathology tests in Australia.
Setting Primary and Tertiary Care.
Measurements The frequency of 25(OH)D testing between 1 April 2006 and 30 October 2010 coded for each individual by provider, state and month between 2006 and 2010. Rate of tests per 100 000 individuals and benefit for 25(OH)D, full blood count (FBC) and bone densitometry by state and quarter between 2000 and 2010.
Results 4.5 million tests were performed between 1 April 2006 and 30 October 2010. 42.9% of individuals had more than one test with some individuals having up to 79 tests in that period. Of these tests, 80% were ordered by general practitioners and 20% by specialists. The rate of 25(OH)D testing increased 94-fold from 2000 to 2010. Rate varied by state whereby the most southern state represented the highest increase and northern state the lowest increase. In contrast, the rate of a universal pathology test such as FBC remained relatively stable increasing 2.5-fold. Of concern, a 0.5-fold (50%) increase in bone densitometry was seen.
Conclusions The marked variation in the frequency of testing for vitamin D deficiency indicates that large sums of potentially unnecessary funds are being expended. The rate of 25(OH)D testing increased exponentially at an unsustainable rate. Consequences of such findings are widespread in terms of cost and effectiveness. Further research is required to determine the drivers and cost benefit of such expenditure. Our data indicate that adoption of specific guidelines may improve efficiency and effectiveness of 25(OH)D testing.
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