The impact of demand management on vitamin D testing

25-hydroxyvitamin D (25-OH-D) is essential for calcium homeostasis and bone health, with increasing evidence suggesting associations with non-skeletal diseases. However, the lack of consensus on optimal concentrations and laboratory variability has led to clinical uncertainty and excessive testing. This study evaluates the impact of demand management strategies and revised cut-off points on test volumes, unperformed determinations, and cost savings.

A retrospective study (January 2015-May 2024) analyzed all 25-OH-D requests. Concentrations of 25-OH-D were measured using electrochemiluminescence assays on a Cobas C8000. An annual trend analysis of 25-OH-D test requests was performed to evaluate changes in demand. In 2018, vitamin D deficiency prevalence was assessed according to three cut-off values (75, 50 and 30 nmol/L). We assessed the impact of demand management rules, implemented in May 2022, to reduce unnecessary testing. The follow-up testing rate was calculated as the proportion of repeat tests within 12 months after determination.

There was 25-OH-D testing increased from 10,830 in 2015 to nearly 85,000 in 2023. Demand management strategies led to 12,406 rejections in 2022 (from May onwards), 16,809 in 2023, and 7566 in 2024 (until May), saving €85,600. Follow-up testing rates dropped from ~15% before 2022 to ~5% afterward. Lowering the deficiency threshold from 75 to 50 nmol/L reduced deficiency diagnoses from > 70% to < 50%; at 30 nmol/L, rates could drop to ~10-11%.

Demand management strategies effectively reduce unnecessary testing and healthcare costs. Establishing appropriate reference values prevents overestimation of vitamin D deficiency, optimizing clinical and economic outcomes.