Overdiagnosis and overuse of diagnostic and screening tests in low-income and middle-income countries: a scoping review
Objective Overdiagnosis and overuse of healthcare services harm individuals, take resources that could be used to address underuse, and threaten the sustainability of health systems. These problems are attracting increasing attention in low-income and middle-income countries (LMICs). Unaware of any...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2022-10-01
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| Series: | BMJ Global Health |
| Online Access: | https://gh.bmj.com/content/7/10/e008696.full |
| _version_ | 1811194083019849728 |
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| author | Ray Moynihan Thanya Pathirana Minna Johansson Loai Albarqouni Eddy Lang Morteza Arab-Zozani Justin Clark Karen Born Hannah Greenwood Eman Abukmail Karin Kopitowski |
| author_facet | Ray Moynihan Thanya Pathirana Minna Johansson Loai Albarqouni Eddy Lang Morteza Arab-Zozani Justin Clark Karen Born Hannah Greenwood Eman Abukmail Karin Kopitowski |
| author_sort | Ray Moynihan |
| collection | DOAJ |
| description | Objective Overdiagnosis and overuse of healthcare services harm individuals, take resources that could be used to address underuse, and threaten the sustainability of health systems. These problems are attracting increasing attention in low-income and middle-income countries (LMICs). Unaware of any review of relevant evidence, we conducted a scoping review of the evidence around overdiagnosis and overuse of diagnostic and screening tests in LMICs.Design Scoping review.Methods We searched PubMed, Embase, PsycINFO, Global Index Medicus for relevant studies published until 24 May 2021, with no restrictions on date or language. We categorised included studies by major focus (overdiagnosis, overuse of tests, or both) and main themes (presence or estimates of extent; drivers; consequences and solutions).Results We identified 2763 unique records and included 162 articles reporting on 154 studies across 55 countries, involving over 2.8 million participants and/or requests for tests. Almost half the studies focused on overdiagnosis (70; 45.5%), one-third on overuse of tests (61; 39.6%) and one-fifth on both (23; 14.9%). Common overdiagnosed conditions included malaria (61; 39.6%) and thyroid cancer (25; 16.2%), estimated to be >70% in China. Overused tests included imaging (n=25 studies) such as CT and MRI; laboratory investigations (n=18) such as serological tests and tumour markers; and procedures (n=14) such as colonoscopy. Drivers included fear of conflict with patients and expanding disease definitions. Common consequences included unnecessary treatments such as antimalarials, and wasted resources, with costs of malaria overdiagnosis estimated at US$86 million in Sudan in 1 year alone. Only 9% of studies discussed solutions, which included addressing inappropriately lowered diagnostic thresholds and reforming test-ordering processes.Conclusions Overdiagnosis and overuse of tests are widespread in LMICs and generate significant harm and waste. Better understanding of the problems and robust evaluation of solutions is needed, informed by a new global alliance of researchers and policy-makers. |
| first_indexed | 2024-04-12T00:20:12Z |
| format | Article |
| id | doaj.art-625c85588fab4949a79cdb503765f7ca |
| institution | Directory Open Access Journal |
| issn | 2059-7908 |
| language | English |
| last_indexed | 2024-04-12T00:20:12Z |
| publishDate | 2022-10-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Global Health |
| spelling | doaj.art-625c85588fab4949a79cdb503765f7ca2022-12-22T03:55:44ZengBMJ Publishing GroupBMJ Global Health2059-79082022-10-0171010.1136/bmjgh-2022-008696Overdiagnosis and overuse of diagnostic and screening tests in low-income and middle-income countries: a scoping reviewRay Moynihan0Thanya Pathirana1Minna Johansson2Loai Albarqouni3Eddy Lang4Morteza Arab-Zozani5Justin Clark6Karen Born7Hannah Greenwood8Eman Abukmail9Karin Kopitowski101 Institute for Evidence-Based Healthcare (IEBH), Bond University, Gold Coast, Queensland, Australia1 Institute for Evidence-Based Healthcare (IEBH), Bond University, Gold Coast, Queensland, AustraliaCochrane Sweden, Lund, SwedenInstitute for Evidence-Based Healthcare, Bond University Faculty of Health Sciences and Medicine, Gold Coast, QLD, Australia7 Department of Emergency Medicine, University of Calgary, Calgary, Alberta, Canada2 Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran1 Institute for Evidence-Based Healthcare (IEBH), Bond University, Gold Coast, Queensland, Australia5 Department of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg University, Gothenburg, Sweden1 Institute for Evidence-Based Healthcare (IEBH), Bond University, Gold Coast, Queensland, Australia1 Institute for Evidence-Based Healthcare (IEBH), Bond University, Gold Coast, Queensland, Australia4 Directora Departamento de Investigación, Instituto Universitario Hospital Italiano, Argentina, ArgentinaObjective Overdiagnosis and overuse of healthcare services harm individuals, take resources that could be used to address underuse, and threaten the sustainability of health systems. These problems are attracting increasing attention in low-income and middle-income countries (LMICs). Unaware of any review of relevant evidence, we conducted a scoping review of the evidence around overdiagnosis and overuse of diagnostic and screening tests in LMICs.Design Scoping review.Methods We searched PubMed, Embase, PsycINFO, Global Index Medicus for relevant studies published until 24 May 2021, with no restrictions on date or language. We categorised included studies by major focus (overdiagnosis, overuse of tests, or both) and main themes (presence or estimates of extent; drivers; consequences and solutions).Results We identified 2763 unique records and included 162 articles reporting on 154 studies across 55 countries, involving over 2.8 million participants and/or requests for tests. Almost half the studies focused on overdiagnosis (70; 45.5%), one-third on overuse of tests (61; 39.6%) and one-fifth on both (23; 14.9%). Common overdiagnosed conditions included malaria (61; 39.6%) and thyroid cancer (25; 16.2%), estimated to be >70% in China. Overused tests included imaging (n=25 studies) such as CT and MRI; laboratory investigations (n=18) such as serological tests and tumour markers; and procedures (n=14) such as colonoscopy. Drivers included fear of conflict with patients and expanding disease definitions. Common consequences included unnecessary treatments such as antimalarials, and wasted resources, with costs of malaria overdiagnosis estimated at US$86 million in Sudan in 1 year alone. Only 9% of studies discussed solutions, which included addressing inappropriately lowered diagnostic thresholds and reforming test-ordering processes.Conclusions Overdiagnosis and overuse of tests are widespread in LMICs and generate significant harm and waste. Better understanding of the problems and robust evaluation of solutions is needed, informed by a new global alliance of researchers and policy-makers.https://gh.bmj.com/content/7/10/e008696.full |
| spellingShingle | Ray Moynihan Thanya Pathirana Minna Johansson Loai Albarqouni Eddy Lang Morteza Arab-Zozani Justin Clark Karen Born Hannah Greenwood Eman Abukmail Karin Kopitowski Overdiagnosis and overuse of diagnostic and screening tests in low-income and middle-income countries: a scoping review BMJ Global Health |
| title | Overdiagnosis and overuse of diagnostic and screening tests in low-income and middle-income countries: a scoping review |
| title_full | Overdiagnosis and overuse of diagnostic and screening tests in low-income and middle-income countries: a scoping review |
| title_fullStr | Overdiagnosis and overuse of diagnostic and screening tests in low-income and middle-income countries: a scoping review |
| title_full_unstemmed | Overdiagnosis and overuse of diagnostic and screening tests in low-income and middle-income countries: a scoping review |
| title_short | Overdiagnosis and overuse of diagnostic and screening tests in low-income and middle-income countries: a scoping review |
| title_sort | overdiagnosis and overuse of diagnostic and screening tests in low income and middle income countries a scoping review |
| url | https://gh.bmj.com/content/7/10/e008696.full |
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