Jim Wong
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Dr Wong is a Geriatric Advanced Trainee working at Cairns Hospital. He graduated from University of Adelaide and completed BPT in South Australia. He grew up in Melbourne, remains a Melbourne boy at heart and would love to return home in IMSANZ 2019 to present his research!
Efficacy And Cost Effectiveness Of Thyroid Function Tests – An Analysis Of Outcomes In The Geriatric Wards Of A Secondary Hospital In Regional Australia
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Aims: To analyze current practice and determine if TFT testing (TSH and free T4) is related to any trends in clinical efficiency, health outcomes and cost effectiveness for both patients and the health service, in the context of a geriatric ward in a level 2 regional Australian hospital.
Methods: Retrospective study of 329 admissions between 1st January 2018 to 30th June 2018. 10 variables were analyzed and 4 outcomes were measured. Partition modelling was used to identify variables which could significantly affect outcomes and chi square analysis was utilized to determine statistical significance.
Results: Total of 329 admissions met inclusion criteria (mean age 80.2, SD = 9.6, male = 45%, n = 148). 219 had TFT’s tested at some stage during their admission, of which, 0.45% (n = 1) were positive for true hypothyroidism (TSH > 4.5 mU/L and fT4 <7 pmol/L) while 10% (n = 22) resulted in subclinical hypothyroidism (TSH > 4.5 mU/L but fT4 within normal range). Of the positive tests, 42% already had a diagnosis of hypothyroidism, and only 13.6% stimulated a change in management. Overall, only 0.30% of the cohort was deemed to have benefited from TFT screening within the 6-month study period.
Conclusion: Our recommendation is that TFT’s as a routine geriatric screening test in an inpatient setting are not a cost effective measure. Number needed to diagnose was 219 tests, resulting in $7,621.20 spent per patient with hypothyroidism. Emphasis should be placed on history and clinical examination, prior to ordering further investigations to confirm or rebuke a clinical diagnosis, as opposed to routine screening on every admission.
Methods: Retrospective study of 329 admissions between 1st January 2018 to 30th June 2018. 10 variables were analyzed and 4 outcomes were measured. Partition modelling was used to identify variables which could significantly affect outcomes and chi square analysis was utilized to determine statistical significance.
Results: Total of 329 admissions met inclusion criteria (mean age 80.2, SD = 9.6, male = 45%, n = 148). 219 had TFT’s tested at some stage during their admission, of which, 0.45% (n = 1) were positive for true hypothyroidism (TSH > 4.5 mU/L and fT4 <7 pmol/L) while 10% (n = 22) resulted in subclinical hypothyroidism (TSH > 4.5 mU/L but fT4 within normal range). Of the positive tests, 42% already had a diagnosis of hypothyroidism, and only 13.6% stimulated a change in management. Overall, only 0.30% of the cohort was deemed to have benefited from TFT screening within the 6-month study period.
Conclusion: Our recommendation is that TFT’s as a routine geriatric screening test in an inpatient setting are not a cost effective measure. Number needed to diagnose was 219 tests, resulting in $7,621.20 spent per patient with hypothyroidism. Emphasis should be placed on history and clinical examination, prior to ordering further investigations to confirm or rebuke a clinical diagnosis, as opposed to routine screening on every admission.