Volume 197 - Issue 2
The rising cost of vitamin D testing in Australia: time to establish guidelines for testing
Authors: Kellie L Bilinski and Steven C Boyages
Med J Aust 2012; 197 (2): 90. || doi: 10.5694/mja12.10561
Published online: 16 July 2012
Published online: 16 July 2012
To the Editor: A rising awareness of the prevalence of 25-hydroxyvitamin D (25OHD) deficiency over the past decade is likely to have led to a surge in the number of individuals who undergo 25OHD testing.1 United States data indicate that testing for 25OHD has increased by 80%-90% annually,2 yet there are no reports that investigate the cost of 25OHD testing in Australia. We analysed the ...
To the Editor: A rising awareness of the prevalence of 25-hydroxyvitamin D (25OHD) deficiency over the past decade is likely to have led to a surge in the number of individuals who undergo 25OHD testing.1 United States data indicate that testing for 25OHD has increased by 80%–90% annually,2 yet there are no reports that investigate the cost of 25OHD testing in Australia. We analysed the Medicare Benefits Schedule (MBS) to determine the economic impact of vitamin D testing in Australia from 1 January 2000 to 31 December 2010.
We found that the annual benefit for 25OHD testing subsidised by the MBS increased from $1.02 million in 2000 to $96.7 million in 2010, an average increase of approximately 59% per year (Box). This increase in 25OHD testing has risen above the general trend of other common pathology tests such as full blood count. Benefits paid by state resemble the population distribution, whereby most benefits in 2010 were paid in New South Wales ($35.3 million) and Victoria ($36.6 million), followed by South Australia ($7.6 million), Queensland ($6.6 million) and Western Australia ($6.4 million), with Tasmania, the Australian Capital Territory and Northern Territory receiving the least benefits ($2.4 million, $1.9 million and $0.2 million, respectively).
Does the current rate of 25OHD testing provide value for money? On the one hand, the increased rate of testing suggests that there may be value by virtue of better detection and intervention to avoid the consequences of 25OHD deficiency. On the other hand, the rate of rise and the high frequency of testing in individuals suggest that better value could be derived. Subgroup analysis between 1 April 2006 and 31 October 2010 showed that although 49.5% of individuals had an average of two tests in that period, 14.5% had over four tests, and 8.2% had over five tests (with some individuals having up to 79 tests in that period).
These preliminary data strongly indicate that 25OHD testing is consuming a large amount of the annual health budget. Our data show that more stringent guidelines should be developed for testing frequency for 25OHD. If 25OHD tests were limited to three per individual annually, based on current rates of testing, a saving of more than $20 million would be achieved over 4 and a half years. Finally, further studies are required to determine whether this increased testing translates into improved health outcomes.
Competing interests
No relevant disclosures.
References
- Boyages S, Bilinski K. Seasonal reduction in vitamin D level persists into spring in NSW Australia: implications for monitoring and replacement therapy. Clin Endocrinol (Oxf) 2012; Apr 3 [Epub]. doi: 10.1111/j.1365-2265.2012.04398.x 0_CBBCHFDD
- Singh RJ. Are clinical laboratories prepared for accurate testing of 25-hydroxy vitamin D? [Letter]. Clin Chem 2008; 54: 221-223. 0_i1142938