Unnecessary vitamin D testing has hit the adapted “triple bottom line” for low-value healthcare – it provides little or no improvement in health outcomes, adds significant costs and contributes avoidable CO2 equivalent (CO2e) emissions, an Australian study shows.
The dismal scorecard strongly suggests vitamin D testing should be discouraged in healthy individuals who are not at known risk of deficiency, according to Sydney University researchers.
Published in BMJ Open (link), the study estimated the health, financial and environmental impact of vitamin D testing.
Medicare item numbers showed 4,457,657 vitamin D tests were performed in 2020 – 11.8% higher than in the previous years and despite a visible decline in testing coinciding with COVID-19 “stay at home” orders.
Applying the evidence from a previous study, the investigators said 3,410 108 tests (76.5%) delivered no health benefit to patients while costing $87,229,690.
They also calculated the carbon footprint arising from the plastic and electricity required to run unnecessary vitamin D testing at 28,576 kg CO2e.
The carbon footprint was equivalent to driving from Sydney to Perth 40 times (157,970 km) in a standard petrol-fuelled passenger car.
The study did not include additional environmental impacts arising from vitamin D testing, such as clinical waste and air and water pollution.
“Our triple bottom line assessment highlights the large number of vitamin D tests providing no net health benefit (>3 million per year) conducted in Australia,” they said.
“Given that efforts to date to reduce low-value care in general, and unnecessary testing specifically, have been met with only limited success, triple bottom line assessments may help by using carbon emission reduction targets to provide additional motivation and incentive for change by underscoring the environmental cobenefits of reducing low-value care.”
“As low-value care represents approximately 30% of total healthcare, the potential to realise environmental cobenefits is significant.”
The investigators, including Professor Alexandra Barratt from the University of Sydney’s School of Public Health, said they used vitamin D testing as a demonstration case of the adapted triple bottom line approach.
“Triple bottom line assessments like this one could provide a more comprehensive picture of the total costs to society of low-value care and may help strengthen and accelerate the decarbonisation of healthcare.”