Article Text

Original research
Consequences of early thyroid ultrasound on subsequent tests, morbidity and costs: an explorative analysis of routine health data from German ambulatory care
  1. Susann Hueber1,
  2. Valeria Biermann2,
  3. Johanna Tomandl1,
  4. Lisette Warkentin1,
  5. Angela Schedlbauer1,
  6. Harald Tauchmann3,
  7. David Klemperer1,
  8. Maria Lehmann4,
  9. Ewan Donnachie5,
  10. Thomas Kühlein1
  1. 1 Institute of General Practice, Universitätsklinikum Erlangen, Erlangen, Bayern, Germany
  2. 2 Chair of Health Management, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Bayern, Germany
  3. 3 Professorship of Health Economics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nürnberg, Bayern, Germany
  4. 4 Institute for Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Bayern, Germany
  5. 5 Bavarian Association of Statutory Health Insurance Physicians, Munich, Germany
  1. Correspondence to Dr Susann Hueber; susann.hueber{at}uk-erlangen.de

Abstract

Objectives This study aims to evaluate whether the use of thyroid ultrasound (US) early in the work-up of suspected thyroid disorders triggers cascade effects of medical procedures and to analyse effects on morbidity, healthcare usage and costs.

Study design Retrospective analysis of claims data from ambulatory care (2012–2017).

Setting Primary care in Bavaria, Germany, 13 million inhabitants.

Participants Patients having received a thyroid stimulating hormone (TSH) test were allocated to (1) observation group: TSH test followed by an early US within 28 days or (2) control group: TSH test, but no early US. Propensity score matching was used adjusting for socio-demographic characteristics, morbidity and symptom diagnosis (N=41 065 per group after matching).

Primary and secondary outcome measures Using cluster analysis, groups were identified regarding frequency of follow-up TSH tests and/or US and compared.

Results Four subgroups were identified: cluster 1: 22.8% of patients, mean (M)=1.6 TSH tests; cluster 2: 16.6% of patients, M=4.7 TSH tests; cluster 3: 54.4% of patients, M=3.3 TSH tests, 1.8 US; cluster 4: 6.2% of patients, M=10.9 TSH tests, 3.9 US. Overall, reasons that explain the tests could rarely be found. An early US was mostly found in clusters 3 and 4 (83.2% and 76.1%, respectively, were part of the observation group). In cluster 4 there were more women, thyroid-specific morbidity and costs were higher and the early US was more likely to be performed by specialists in nuclear medicine or radiologists.

Conclusion Presumably unnecessary tests in the field of suspected thyroid diseases seem to be frequent, contributing to cascades effects. Neither German nor international guidelines provide clear recommendations for or against US screening. Therefore, guidelines on when to apply US and when not are urgently needed.

  • Thyroid disease
  • ULTRASONOGRAPHY
  • PRIMARY CARE

Data availability statement

Data are available upon reasonable request. The data that support the findings of this study are available from the Bavarian Association of Statutory Health Insurance Physicians but restrictions apply to the availability of these data, which were used under licence for the current study and are not publicly available. Data may be obtained from the authors upon reasonable request and with permission of the Bavarian Association of Statutory Health Insurance Physicians.

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Data availability statement

Data are available upon reasonable request. The data that support the findings of this study are available from the Bavarian Association of Statutory Health Insurance Physicians but restrictions apply to the availability of these data, which were used under licence for the current study and are not publicly available. Data may be obtained from the authors upon reasonable request and with permission of the Bavarian Association of Statutory Health Insurance Physicians.

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Footnotes

  • Contributors SH, TK, AS, HT and ED initiated and designed the study. SH, VB, JT, LW, AS, HT, ML, ED and TK carried out data analysis. SH acted as guarantor. All authors contributed to interpreting the results. SH was the primary contributor in writing the manuscript, with major contributions from TK, JT, HT and LW. All authors contributed to writing of the manuscript, commented on the draft and approved the final version of the manuscript.

  • Funding This research was conducted within the research network PRO PRICARE, Preventing Overdiagnosis in Primary Care and supported by the German Federal Ministry of Education and Research (grant 01GY1605).We acknowledge financial support by Deutsche Forschungsgemeinschaft and Friedrich-Alexander-Universität Erlangen-Nürnberg within the funding programme "Open Access Publication Funding".

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.