Diagnostic testing managed by hematopathology specialty and other laboratories: costs and patient diagnostic outcomes

BMC Clinical Pathology

April Teitelbaum²  Jeffrey McPheeters³  Erin M Hulbert³  Priyanka Koka³  Rui Song³  Benjamin Eckert⁴  Nicole M Engel-Nitz¹ 

[1] Health Economics and Outcomes Research, Optum, 12125 Technology Drive, Eden Prairie, MN 53344, USA;AHT BioPharma Advisory Services, Carlsbad, CA, USA;Optum, Eden Prairie, MN, USA;Present address Metamark Genetics, Cambridge, MA, USA

关键词: Lymphoma;    Leukemia;    Hematopathology;    Diagnostic costs;    Diagnostic laboratory tests;   

Others  :  821333
DOI  :  10.1186/1472-6890-14-17

 received in 2013-03-07, accepted in 2014-04-17,  发布年份 2014

【 摘 要 】

Background

Successful management of patients with hematologic malignancies depends upon accurate and timely diagnosis, which frequently requires integration and interpretation of multiple tests. Our retrospective analysis compared diagnostic uncertainty, resource utilization, and costs for patients with diagnostic bone marrow (BM) tests managed by commercial laboratories.

Methods

Patients with BM biopsies and suspected hematologic cancer/condition were identified from claims (2005–2011) within a large US health plan (coverage ≥6 pre- and ≥3-months post-biopsy). Cohorts defined by laboratories performing BM morphologic assessment/directing testing sequence: Genoptix (GX, specialty hematology-testing laboratory), large commercial laboratories (LL), other laboratories (OL). One-year post-biopsy changes in diagnosis or treatments, tests performed, and diagnostic/treatment medical costs (measured as per-patient-per-month [PPPM]) were examined.

Results

The study population included 1,387 GX, 4,162 LL, and 19,115 OL patients with suspected hematologic malignancy/disease and BM morphology assessment. GX had lower diagnostic uncertainty measured between 2 time periods by diagnostic stability (no conditions the same; 6.16% GX, 8.04% LL, 9.73% OL; p < 0.001) and changes (≥1 condition different; 7.88% GX, 11.19% LL, and 14.08% OL; p < 0.001), fewer repeat BM biopsies, and fewer chemotherapy changes (30-days and 60-days post-initiation). One-year PPPM costs adjusted for patient characteristics differences were $8,202 GX, $7,711 LL, and $10,302 OL (p < 0.05); adjusted PPPM costs (excluding testing period) were $6,019 GX, $6,649 LL, and $7,801 OL (p < 0.05).

Conclusions

Our data suggests that a hematopathology specialty laboratory may result in earlier final diagnosis, fewer subsequent diagnosis changes, reduced need for follow-on testing requiring repeat biopsy procedures, and may result in lower downstream healthcare costs. Further evaluations using medical chart abstractions or registries will be valuable.

【 授权许可】

   
2014 Engel-Nitz et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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