Short- and medium-term cost effects of non-indicated thyroid diagnostics: empirical evidence from German claims data

Abstract

This paper contributes to the discussion of whether non-indicated ultrasound examinations of the thyroid gland contribute to overtreatment and excess health care expenditures. Using two sources of claims data from Germany, we analyzed data from patients who underwent a TSH blood test which is the initial diagnostic measure to check for possible presence of thyroid dysfunction. In a matching analysis, we compared health costs of two groups of patients. One consisted of patients who underwent an early thyroid ultrasound that according to medical guidelines—at this point—was probably not indicated. The other group consisted of patients, who underwent no ultrasound examination at all or later in the course of the disease, making probable a correct indication. Both groups were made comparable by the means of a matching procedure. Average thyroid-specific health costs were substantially higher for the first group in the quarter in which the ultrasound examination took place. Some deviation in these specific costs persisted over a substantial period of time, with drug expenditures exhibiting the biggest difference. If, however, total health costs were considered, difference in costs was only found in the initial quarter. We conclude that non-indicated ultrasound examination of the thyroid gland may have some moderate effects on thyroid-specific costs. Yet the data do not suggest that long-lasting overtreatment and excess health expenditures are initiated by non-indicated ultrasound in Germany.

Consequences of early thyroid ultrasound on subsequent tests, morbidity and costs: an explorative analysis of routine health data from German ambulatory care

“…Since it is estimated that up to 90% of thyroid cancer diagnoses are attributable to overdiagnosis in South Korea and Italy and up to 60% in Nordic countries,5 6 it is not hard to understand how much financial resources are wasted. However, the analysis of Hafner et al showed that only minor increases in costs are associated with follow-up tests arising from early thyroid US 28. However, further robust and reliable data are needed for Germany to evaluate additional costs for overdiagnosis of thyroid diseases.…”

“…However, the analysis of Hafner et al showed that only minor increases in costs are associated with follow-up tests arising from early thyroid US. 28 However, further robust and reliable data are needed for Germany to evaluate additional costs for overdiagnosis of thyroid diseases.…”

“…A first analysis of costs arising from the early and presumably non-indicated thyroid US revealed some moderate effects on thyroid-specific costs. 28 The effects on morbidity and patients' healthcare usage have not been analysed. Therefore, the study presented here is intended to evaluate whether the use of thyroid US early in the work-up of suspected thyroid disorders triggers cascade effects of medical procedures.…”

“…One of the network’s projects focused on the investigation of cascade effects arising from the early use of US in the work-up of suspected thyroid diseases using routine healthcare data. A first analysis of costs arising from the early and presumably non-indicated thyroid US revealed some moderate effects on thyroid-specific costs 28. The effects on morbidity and patients’ healthcare usage have not been analysed.…”

Overuse of thyroid ultrasound

“…While TUS is necessary for some patients with strong indications, its use in patients without one can lead to potential negative consequences, such as thyroid cancer overdiagnosis and overtreatment. [8 ▪ ,11,12,18 ▪▪ ,19].…”