How much more does it cost the medical system to have doctors order vitamin D blood tests? Already, both Canada and Medicare have limited doctor’s ability to test for vitamin D deficiency because the tests cost too much. How much do they cost in the picture of total health care costs?
The stunning answer from Dr. Beth Baily and colleagues at East Tennessee State University is that frequent vitamin D blood tests mean lower, not higher, total medical care costs. That’s right, ordering more vitamin D tests means lower total health care costs.
Bailey, Beth et al. Vitamin D Testing Patterns Among Six Veterans Medical Centers in the Southeastern United States: Links With Medical Costs. Military Medicine, Volume 177, Number 1, January 2012 , pp. 70-76(7)
The researchers looked at the medical records of about 400,000 veterans from six VA medical centers in the Southeastern United States to find about 15,000 veterans who had a vitamin D level checked. Then they added up the total number of subsequent visits (inpatient and outpatient) and the total subsequent health care cost for each veteran, vitamin D tested or not.
As expected, outpatient costs were a little higher for veterans who had vitamin D testing. Then came the real shocker: average inpatient costs per patient were from 50% to 56% lower for veterans who had two follow-up vitamin D tests compared to no follow up test. The study also showed that the veterans who have been tested and effectively treated for their vitamin D deficiency have the lowest yearly inpatient costs, while the sites that have done the least testing had inpatient costs nearly triple that. While the authors were quick to point out vitamin D did not explain all of this huge difference, it clearly seemed to explain at least some of it and leaves one with the tragic reality that some of our veterans are dying needlessly.
I was so glad to see that the authors write, “The (local) VAMC has made a concerted effort to educate local health care providers regarding vitamin D deficiency over the past few years.” They went on the say, “Immediate implementation of this recommendation is highly desirable.” I agree. This is a public health problem that needs to be immediately treated with public health measures, including better sun exposure guidelines, supplementation guidelines, and food fortification.
Hats off to Drs. Beth Bailey, Todd Manning, and Alan Peiris, and my apologies to the others in the Tennessee VA system that I missed. They have discovered reduced total health care costs in veterans are associated with more vitamin D testing and less expensive subsequent hospital stays. They are government servants of the highest order. Therefore, it appears that Medicare has cut off its nose to spite its face, limiting vitamin D blood tests to save a little money, thus assuring that total costs of treating the elderly will be substantially higher. Now, how can we get this information to President Obama?
EDITED 3/24/12 by Brant Cebulla