Friday, 14 August 2015

Are Vitamin D tests testing the health budget?

SPHPM’s Associate Professor Anita Wluka, Associate Professor Ben Smith, Usha Gowda, and Associate Professor Andre Renzaho have conducted a study into the frequency and testing patterns for Vitamin D deficiency that raises questions about best practice and the financial impact on health spending in Australia. The paper on the research was co-authored with David Fong and Ambika Kaur from the Doutta Galla Community Health Service.

The study sought to explore and critique the existing testing patterns that general practitioners use in Victoria to determine vitamin D levels, a practice that has seen a global influx in more recent years. Data collected and analysed from the Medicare Benefits Schedule indicated that across an 11 year period, vitamin D testing has increased 94-fold. As such, the cost involved has increased from $1.02 million to $96.75 in this time period, putting significant strain on the annual health budget.

“This study aimed to examine 25(OH) D testing patterns by GPs as well as identifying patient characteristics associated with higher levels of testing. We found that 55.6 per cent of eligible patients in the study were tested for Vitamin D deficiency, which is obviously a significant proportion,” Associate Professor Wluka said.

There are conflicting views regarding the prevalence of vitamin D testing, with various medical professionals raising concerns that vitamin D deficiency has been over-diagnosed. A series of studies state that over-screening or over-diagnosing can lead to labelling that may not be required or result in harm from unnecessary tests, also raising the question of the cost-benefit ratio involved in these diagnoses. Existing recommendations suggest that those who are at a higher rate of risk of vitamin D, such as the elderly, should be tested. There is however, no universally accepted decision on the frequency or timing of testing for vitamin D deficiency.

“It is important to assess and test high risk groups; however the incidence of possible over-testing needs to be considered. Evidence-based policies and improved guidelines on testing frequency are needed and could provide significant savings in annual healthcare expenditure,” Associate Professor Wluka said.

There is an increased risk of deficiency in females, the elderly and migrant populations, therefore these individuals may be getting tested more often. Existing studies on vitamin D testing patterns have not specifically assessed the influence of socioeconomic factors, demographic factors and migration status on the frequency of being tested. The results of this study did not indicate a significant testing pattern between patients in most disadvantaged areas and least disadvantaged areas.

As a part of this study, the researchers conducted a three-year clinical audit (from 2010 to 2012) at a major metropolitan community health centre in the western region of Melbourne . The patients included in the audit were over the age of 18. Univariate and multivariate logistic regression was utilised to scrutinize the association between vitamin D testing patterns and socio-demographic characteristics with Poisson regression then being utilised to determine the testing frequency.

A total of 1,217 patients tested for vitamin D; the majority were female (59.8 per cent) and 65.7 per cent of migrants were tested compared to only 42.1 per cent on non-migrants.. The odds of vitamin D tests indicated a weak positive association with age and the frequency of testing was also higher in females rather than males. This also applied to migrants compared to non-migrants.

“Another option, in addition to evidence-based testing guidelines, could be raising the current recommended daily supplement dose of 800IU for those at risk of Vitamin D deficiency, and refraining from testing unless risk factors changed for the patient,” Associate Professor Wluka said.

You can read the research paper here

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