The rise of direct-to-consumer testing: is the NHS paying the price?

Abstract

The rise of direct-to-consumer testing: is the NHS paying the price? Dozens of UK companies are offering private tests for a range of conditions and deficiencies. Some make claims that exceed the evidence base, and experts say regulation is needed to protect patients. Emma Wilkinson reportsEmma Wilkinson freelance journalist "Take your health into your hands today," reads an advertisement for the Livit app, from Nightingale Health. Costing €179 (£155; $176), it encourages four blood tests a year, using "highly advanced blood analysis technology," and promises to predict how many healthy years of life a person has left. 1 The market for direct-to-consumer tests such as Livit is booming, with one piece of market research predicting that the global blood testing market will rise by 60% from around $80.50bn in 2021 to $128.45bn in 2028. 2 Experts are concerned that such companies are making misleading claims and leaving an already overworked NHS to follow up "abnormal results." Some have also warned of a lack of regulation to ensure that consumers truly know what test results mean.The BMJ's investigation has led us to refer two companies to the UK Advertising Standards Authority for misleading claims about the accuracy or detection rates associated with at-home tests. Another removed tests from its website after we got in touch (box 1). But in many cases it is the absence of information that is the problem, says Chris Salisbury, professor of primary healthcare at the University of Bristol. "There is a simplistic assumption that more information is better, so why shouldn't you get the tests done? Yet they're making claims without showing any of the disadvantages," he says.

Direct-to-consumer tests advertised online in Australia and their implications for medical overuse: systematic online review and a typology of clinical utility

“…Testing, whether using home testing kits or at a laboratory, is resource intensive and produces medical waste 15. Testing demands further clinical resources such as analysis and interpretation, and decision-making based on results, whether positive or negative 16 17. Test results can also trigger downstream testing and unjustified treatments that generate further costs and resource-use in the health system, such as unnecessary general practitioner (GP) visits 18 19.…”

“…When testing decisions are not clinically justified or do not lead to improvement in health outcomes, they are a form of ‘low-value care’, creating waste and additional burden to the healthcare system 20. Although it is well recognised that medical overuse occurs even in clinician-guided settings,13 21 it may be exacerbated in a DTC context where consumers may be making testing decisions with little support or balanced information 17…”

Why blood testing companies need effective regulation

“…In the UK, regulation prevents prescription only medications being advertised directly to consumers, but not medical tests. The BMJ ’s investigation has found dozens of companies offering health screening for a range of conditions and deficiencies through blood testing kits for use at home, often advertised to people with symptoms such as tiredness, low energy, irritability, sleep problems, and problems with weight 1…”

“…Claims made by companies for screening often exceed the evidence base. One company offered a refund if none of the screening tests fell outside “normal” ranges 1. Given that reference ranges are conventionally defined as the range that encompasses 95% of the “normal” population, few people will have no “abnormal” results when multiple biomarkers are tested.…”

Health and climate crises will shape Sunak’s legacy

“…Our investigation into direct-to-consumer advertising of private testing services for diagnostic and prognostic purposes should prompt a further government review and regulatory change (doi:10.1136/bmj.o2518). 15 The harms of commercially driven, non-evidence based screening tests include placing an added burden on taxpayer funded care, which has to pick up the cost and the responsibility of following up “abnormal” findings (doi:10.1136/bmj.o2517). 16 We have reported two companies to UK’s advertising standards authority.…”