Presentation (CTI)

Problem Statement: Testing for vitamin D deficiency had been observed to increase in Switzerland, despite concerns regarding the benefits of vitamin D testing prior to vitamin D supplementation, thereby contributing to increased costs for the Swiss mandatory health insurance system.
Description: The Swiss Federal Office of Public Heath (FOPH) initiated an HTA to evaluate the available clinical and economic evidence on vitamin D testing. The HTA report published in 2020 found a lack of available evidence for vitamin D testing for at-risk groups. In 2021, Choosing Wisely Switzerland independently published their recommendation against routine vitamin D testing for patients without risk factors. In 2022, the FOPH restricted coverage of vitamin D tests under compulsory health insurance, limiting reimbursement to specific conditions. An academic research group subsequently conducted an independent retrospective analysis of health insurance claims data to assess the effects of the measures taken since publication of the HTA report. This analysis could demonstrate that the Choosing Wisely recommendation reduced the number of tests prescribed per physician by around 6% within 12 months following the intervention. Coverage restriction reduced the monthly number of tests by around 58% within 6 months.
Lessons Learned: HTA is a powerful tool to induce change in behaviours regarding potentially low-value care.
Stakeholder Perspective: The HTA (payer's perspective) was commissioned by the Swiss Federal Office of Public Heath (FOPH).