Endocrine Abstracts

Objectives: Slovakia is gradually implementing health technology assessment (HTA). This method evaluated the issue of possible overuse of laboratory and imaging investigations in thyroidology for the last 10 years. The analysis being divided between 2008–2011 and 2012–2017. In this study we publish the outputs from the first stage phase.

Methods: The study was conducted using data from patient records of the General Health Insurance Company, a.s., 2011 registered approximately 3 400 000 policyholders (64.7%). Laboratory (fT3, fT4, TSH, ATPO, aTG, thyroglobulin, TRAK) and USG thyroid examinations were assigned a diagnosis E.00-E.07.

Results: The number of examined patients with these diagnoses had a permanent growth tendency: 2008 – 168.200, 2009 – 176.349, 2010 – 229.524, 2011 – 240.662. The same tendency was observed in laboratory examinations: 2008 – 414.904, 2009 – 449.500, 2010 – 605.268, 2011 – 620.378, as well as USG examinations: 2008 – 102.212, 2009 – 109.700, 2010 – 148.528, 2011 – 156.775. Year 2011 brought these results in laboratory examinations: fT4 – 196.785, TbG – 1.247, fT3 – 50.701, aTG – 58.139, aTPO – 64.910, TSH – 237.460, TRAK – 11.136. 2008 was similar in all laboratory examinations. The average number of laboratory and USG examinations per patient was – 3.074 examinations, 2009 – 3.171, 2010 – 3.284, 2011 – 3.229 examinations. The cost of these tests was calculated per 1 patient per year. 2008 – € 23.35, 2009 – € 25.59, 2010 – € 25.82, and € 26.76 in 2011. The total cost of these laboratory/USG examinations was in 2008 – 3 070 828/856 093 €, 2009 – 3 263 430/913 730 €, 2010 – 4 388 179/1 238 203 €, and 2011 – 4 223 686/€ 1,308,098.

Conclusions: Proposals for measures to reduce the costs of overuse of these examinations may be different according to the methodology used (based on the costs of 2011 – 4 223 686 or 1 308 098 €): A. When reducing the reimbursement to the level of the Slovak average, the saving would be approximately 442 535 € (8% of total costs). B. The savings would be around 525 130 € for the selected examinations – 9.49%. C. By reducing the average number of laboratory examinations from 3.4 to 3.0, the savings would reach about € 496 705, i.e. 11.76% and in case of USG testing from 1.15 to 1.0, the savings would reach 170 576 €, ie. 13.04%.