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Unnecessary vitamin D tests cost NHS millions says ARC EM-funded study

More than £38 million could be saved annually by the NHS if the availability of vitamin D testing kits was curbed, a study funded by ARC East Midlands has concluded.

It comes as people have been urged people to take the ‘sunshine vitamin’ to help boost their overall health amid mounting evidence it can protect against COVID-19.

There has been a two to six-fold increase in requests for the sunshine vitamin in the UK during the last 18 years and aside from the claims vitamin D benefits coronavirus patients, this increase in vitamin D is without any clear gain in health benefits, according to a team of researchers from Leicester.

The corresponding costs of analysis of vitamin D in primary care have increased three-fold, with an estimated rise in annual spending of £28 million in 2004 to £76 million in 2011.

In response, this study aimed to determine the impact on vitamin D test ordering across Leicestershire, following a redesign of the electronic request forms used by GP practices to incorporate the latest evidence.

The redesign of the form helped introduce more clinical reasoning to prescribing a vitamin D test, moving it from the first page where it was previously easy to access and acted as more of a tick-box exercise.

This led to a 36.2 per cent decrease in requests for vitamin D, from 41,254 before the change to the form to 26,336 in the period afterwards.

Lead researcher Dr Veena Patel, Consultant Rheumatologist from Leicester’s Hospitals, added: “National and international guidelines recommend vitamin D testing be performed only in those patients who present with symptoms such as bone pain, muscle weakness, symptoms suggestive of rickets, or those patients who have low serum calcium levels. Public Health of England advises everyone not just “at risk” groups to take 10 micrograms (400 international unit) of vitamin D daily.”

Dr Pankaj Gupta, Consultant Metabolic Physician/Chemical Pathologist and HOS Department of Metabolic Medicine and Chemical Pathology who also helped lead the research and is also from Leicester’s Hospitals, said: “We have noticed a year on year increase of 20% in Vitamin D requests over the last few years with a significant impact on resources. Hence measures, such as those highlighted in the manuscript, may lead to a better utilisation of the test.”

Professor Mayur Lakhani, a GP based in Leicester, said: “As a working doctor, I would urge everyone to review their requests for vitamin D testing and avoid ‘routine’ requests which is both unnecessary and wasteful. This is great example of a partnership between the NHS and researchers. The project came directly from concerns raised by GPs about overdiagnosis. The findings show that there are simple and practical ways of reducing unnecessary investigations.”

Cost of testing for vitamin D was obtained from the National Institute for Health and Care Excellence (NICE) economic evaluation published in 2014, which estimated the cost per vitamin D test to be £16.50.

This estimate was adjusted to 2017 prices using the hospital and community health services inflation index and a value of £17.17 per vitamin D test was used in the analysis. 

A cost analysis estimated that a reduction of 36.2 per cent in vitamin D requests would lead to an annual saving of £638,758 across Leicestershire.

Assuming that Leicestershire covers a population of 1,100,415, which constitutes 1.65% of the UK population of 66,579,184, the results can be extrapolated to estimate that delivering the intervention across primary care in the UK could potentially lead to an annual saving of £38,712,606.

Professor Kamlesh Khunti, Director of the ARC EM and Professor of Primary Care Diabetes and Vascular Medicine at the University of Leicester said: “This study shows the impact of implementing a simple pragmatic redesign of the electronic request screens led to a substantial reduction in vitamin D requests by more than one-third. 

“It reduced expenditure by more than half a million pounds in Leicestershire alone, which could translate to a potential saving of around £38 million if implemented across the UK.”

The study was supported by the NIHR Leicester Biomedical Research Centre (BRC).

To access the study, click here.

Published on: 11 Nov 2020