Adherence to minimal retesting interval for HbA1c, vitamin D and thyrotropin in the University Hospital of Nepal.

Abstract

Background: Laboratory testing plays a critical role in healthcare decision-making; however, concerns regarding overutilization and inappropriate testing persist. Minimum retesting intervals serve as a tool to optimize testing practices and resource allocation. This study aimed to assess adherence to minimum retesting interval guidelines and estimate associated costs for commonly prescribed tests, namely HbA1c, 25 hydroxyvitamin D (Vitamin D), and thyrotropin, in a university hospital setting in Nepal.

Methods: This observational study utilized secondary data from medical records covering 1 year. Adherence to minimum retesting interval guidelines was evaluated based on established recommendations, and the economic burden of inappropriate testing was estimated using cost data provided by the Health Insurance Board of Nepal.

Results: Patients who underwent TSH, HbA1c, and Vitamin D testing during the study period were 27,960, 8558, and 5416 with the total number of tests being 38,718 TSH, 13,859 HbA1c, and 5977 Vitamin D, respectively. There were notable proportions of patients with minimum retesting interval breach, that is, n = 1317 for thyroid stimulating hormone (4.71%), n = 1159 for HbA1c (13.54%) and n = 232 for Vitamin D (4.28%). Minimum retesting interval breaches were identified across all parameters, with associated costs of $12,817 which could be saved if there were no minimum retesting interval breaches. Variations in minimum retesting interval adherence were observed between insured and noninsured patients and among tests falling within and outside reference ranges.

Conclusion: The findings highlight the prevalence of minimum retesting interval breaches and inappropriate testing practices, emphasizing the need for interventions to optimize laboratory testing utilization. Addressing these challenges through context-specific strategies can enhance resource allocation and patient care while mitigating financial burdens.