Direct-to-consumer Tests Advertised Online in Australia and Their Implications for Medical Overuse: Systematic Online Review and a Typology of Clinical Utility

Overview

Journal BMJ Open

Specialty General Medicine

Date 2023 Dec 27

PMID 38151277

Authors

Patti Shih

Pauline Ding

Stacy M Carter

Fiona Stanaway

Andrea R Horvath

Daman Langguth

Mirette Saad

Andrew St John

Katy Bell

Affiliations

Soon will be listed here.

Abstract

Objectives: The objective of this study is to map the range and variety of direct-to-consumer (DTC) tests advertised online in Australia and analyse their potential clinical utility and implications for medical overuse.

Design: Systematic online search of DTC test products in Google and Google Shopping. DTC test advertisements data were collected and analysed to develop a typology of potential clinical utility of the tests at population level, assessing their potential benefits and harms using available evidence, informed by concepts of medical overuse.

Results: We identified 484 DTC tests (103 unique products), ranging from $A12.99 to $A1947 in cost (mean $A197.83; median $A148.50). Using our typology, we assigned the tests into one of four categories: tests with potential clinical utility (10.7%); tests with limited clinical utility (30.6%); non-evidence-based commercial 'health checks' (41.9%); and tests whose methods and/or target conditions are not recognised by the general medical community (16.7%). Of the products identified, 56% did not state that they offered pretest or post-test consultation, and 51% did not report analytical performance of the test or laboratory accreditation.

Conclusions: This first-in-Australia study shows most DTC tests sold online have low potential clinical utility, with healthy consumers constituting the main target market. Harms may be caused by overdiagnosis, high rates of false positives and treatment decisions led by non-evidence-based tests, as well as financial costs of unnecessary and inappropriate testing. Regulatory mechanisms should demand a higher standard of evidence of clinical utility and efficacy for DTC tests. Better transparency and reporting of health outcomes, and the development of decision-support resources for consumers are needed.

Citing Articles

Social Media Promotion of Health Tests With Potential for Overdiagnosis or Overuse: Protocol for a Content Analysis.

Nickel B, Heiss R, Shih P, Gram E, Copp T, Taba M JMIR Res Protoc. 2024; 13:e56899.

PMID: 38833693 PMC: 11185923. DOI: 10.2196/56899.

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