ReviewBMJ open2022
Health, financial and environmental impacts of unnecessary vitamin D testing: a triple bottom line assessment adapted for healthcare.
Review in BMJ open, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
23 citing papers in PubMed, 3 syntheses or guidelines pooled it, 39 citations in OpenAlex.
- The 2024 Endocrine Society Guideline on Vitamin D: Comprehensive Summary and Critical Appraisal.Nutrients · 2026Pooled it
- Strategies and tactics to reduce the impact of healthcare on climate change: systematic review.BMJ (Clinical research ed.) · 2024Pooled it
- Behavioural change interventions encouraging clinicians to reduce carbon emissions in clinical activity: a systematic review.BMC health services research · 2023Pooled it
- Exploring the Integration of Environmental Impacts in the Cost Analysis of the Pilot MEL-SELF Trial of Patient-Led Melanoma Surveillance.Applied health economics and health policy · 2023Trial
- Vitamin D: Physiology, Pharmacology and Clinical Evidence for Supplementation-A Narrative Review.Basic & clinical pharmacology & toxicology · 2026Review
- Using Life Cycle Assessments to Measure the Environmental Impact of Alternative Care Models in the Neonatal Intensive Care Unit.International journal of environmental research and public health · 2026Article
- Reducing waste from single-use procedure packs in hospitals: A scoping review.Anaesthesia and intensive care · 2026Article
- Comparison of tWo hospital quality Improvement interventions on inappropriate measurement and SupplEmentation of vitamin D: the WISE-D study.BMC geriatrics · 2026Article
- Healthcare Costs and Carbon Emissions of Stage III Melanoma Surveillance Imaging.Applied health economics and health policy · 2026Article
- Promoting Nordic 'Green Care Practices'.Scandinavian journal of primary health care · 2025Article
- Switch It Off! Carbon, Financial and Health Service Impacts of Switching Off a Computed Tomography Scanner: A Quality Improvement Study.Journal of medical radiation sciences · 2025Article
- Rethinking Vitamin D Deficiency: Controversies and Practical Guidance for Clinical Management.Nutrients · 2025Review
- The impact of Choosing WiselyBMC health services research · 2025Article
- Article
- Reducing the environmental burden of unnecessary investigations.Canadian family physician Medecin de famille canadien · 2025Article
- Reducing The Environmental Footprint of Unnecessary Medical Interventions.Medical journal of the Islamic Republic of Iran · 2025Article
- Optimisation of vitamin D status in global populations.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2024Review
- Review
- Mapping the Environmental Co-Benefits of Reducing Low-Value Care: A Scoping Review and Bibliometric Analysis.International journal of environmental research and public health · 2024Article
- Patient, hospital and environmental costs of unnecessary bloodwork: capturing the triple bottom line of inappropriate care in general surgery patients.BMJ open quality · 2023Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo undertake an assessment of the health, financial and environmental impacts of a well-recognised example of low-value care; inappropriate vitamin D testing.
designCombination of systematic literature search, analysis of routinely collected healthcare data and environmental analysis.
settingAustralian healthcare system.
participantsPopulation of Australia. OUTCOME MEASURES: We took a sustainability approach, measuring the health, financial and environmental impacts of a specific healthcare activity. Unnecessary vitamin D testing rates were estimated from best available published literature; by definition, these provide no gain in health outcomes (in contrast to appropriate/necessary tests). Australian population-based test numbers and healthcare costs were obtained from Medicare for vitamin D pathology services. Carbon emissions in kg CO
resultsThere were a total of 4 457 657 Medicare-funded vitamin D tests in 2020, on average one test for every six Australians, an 11.8% increase from the mean 2018-2019 total. From our literature review, 76.5% of Australia's vitamin D tests provide no net health benefit, equating to 3 410 108 unnecessary tests in 2020. Total costs of unnecessary tests to Medicare amounted to >$A87 000 000. The 2020 carbon footprint of unnecessary vitamin D tests was 28 576 kg (base case) and 42 012 kg (sensitivity) CO
conclusionsUnnecessary vitamin D testing contributes to avoidable CO
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.