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Measuring 21 low-value hospital procedures: claims analysis of Australian private health insurance data (2010–2014)
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  • Published on:
    Response to letter regarding hyperbarix oxygen therapy
    • Kelsey Chalmers, Research Associate Menzies Centre for Health Policy, Sydney School of Public Health, The University of Sydney
    • Other Contributors:
      • Tim Badgery-Parker, Research Fellow
      • Adam G Elshaug, Professor of Health Policy

    We thank Dr Sherlock for their interest in our study and her letter. Defining, identifying and measuring low-value care is complex, and there are multiple potential approaches and solutions. Due to heterogeneous treatment effects and other issues, what is considered low-value will (by definition) encompass more than what is universally accepted as wasted or ‘no-value’ care. In our approach, we developed measures or indicators of low-value care to signpost where further investigation may be required. Episodes with indicated low-value hyperbaric oxygen therapy (HBOT) were in the ‘negligible’ or ‘near zero use of low-value procedures’ in the results for both papers [1, 2]. While the definition for the low-value procedure indication here may be debated, importantly we found that indicated low-value HBOT was uncommon.
    We included HBOT in this list of procedures because it passed our criteria of being a potential measurable low-value procedure within the claims data, especially since a previous study using Australian hospital data had included it [3]. The fact that there was multiple National Institute for Health and Care Excellence (NICE) ‘do not do’ recommendations on HBOT meant that we included it on our list of low-value procedures.

    We used the term ‘multiple indications’ for brevity in the results table in the main text, following guidance from journal editors and sub-editors to do so. We find Dr Sherlock’s critique of this somewhat disingenuous and misleading...

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    Conflict of Interest:
    None declared.
  • Published on:
    Editor's Note

    BMJ Open's editorial team has received the comments from Dr Sherlock on this paper. The authors of the paper have been contacted and have been asked to provide a response.

    Conflict of Interest:
    None declared.
  • Published on:
    Inappropriate Referencing

    The authors of the article “Measuring 21 low- value hospital procedures: claims analysis of Australian private health insurance data (2010-2014)” have perplexingly examined prevalence of low-value procedures without adequately justifying the appearance of hyperbaric oxygen treatment (HBOT) appearing on the list (for” multiple indications”, again not defined)1.
    The same authors made the same mistake in a similar article (Low-value care in Australian public hospitals; prevalence and trends over time) also published in BMJ Quality and Safety this year2. They also quoted the work of another author in that report who made the same error in his paper3. These errors of fact have been reported by several authors yet continue to be presented as factually correct4 5 6.
    Evidence-based medicine requires evidence. To define a list of accepted low-value procedures where not a single reference supports the assertion is misleading at best. The authors claim the list of procedures in this paper (and their previous paper) was based upon recommendations from a variety of sources. This list included the Royal Australasian College of Physicians EVOLVE campaign (hyperbaric does not appear in any recommendation), the Australian Choosing Wisely (CW) campaign (no reference on the website for hyperbaric services), CW Canada (no reference to hyperbaric oxygen), CW UK (hyperbaric not mentioned), the National Institute of Health and Care Excellence Do not Do recommendations (hyperbaric no...

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    Conflict of Interest:
    None declared.