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

Engel-Nitz NM, Eckert B, Song R, Koka P, Hulbert EM, McPheeters J, Teitelbaum A - BMC Clin Pathol (2014)

Bottom Line: 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).Further evaluations using medical chart abstractions or registries will be valuable.

View Article: PubMed Central - HTML - PubMed

Affiliation: Optum, Eden Prairie, MN, USA ; Health Economics and Outcomes Research, Optum, 12125 Technology Drive, Eden Prairie, MN 53344, USA.

ABSTRACT

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.

No MeSH data available.


Related in: MedlinePlus

Study design.
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Figure 1: Study design.

Mentions: This study used administrative claims data from the Optum Research Database (a proprietary database including claims from the large US health plan affiliated with Optum). Medical and pharmacy claims were retrospectively evaluated to identify the patients that had a bone marrow procedure (biopsy/aspirate) claim with suspected hematologic cancer/disease (index date; Figure 1) from 01 July 2005 through 30 June 2011 (eligibility period). The study further identified patients with diagnoses of MDS, myeloproliferative neoplasm (MPN), CLL, non-Hodgkin lymphoma (NHL), MM, other hematologic cancers, and other non-cancer hematologic conditions.


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

Engel-Nitz NM, Eckert B, Song R, Koka P, Hulbert EM, McPheeters J, Teitelbaum A - BMC Clin Pathol (2014)

Study design.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4016629&req=5

Figure 1: Study design.
Mentions: This study used administrative claims data from the Optum Research Database (a proprietary database including claims from the large US health plan affiliated with Optum). Medical and pharmacy claims were retrospectively evaluated to identify the patients that had a bone marrow procedure (biopsy/aspirate) claim with suspected hematologic cancer/disease (index date; Figure 1) from 01 July 2005 through 30 June 2011 (eligibility period). The study further identified patients with diagnoses of MDS, myeloproliferative neoplasm (MPN), CLL, non-Hodgkin lymphoma (NHL), MM, other hematologic cancers, and other non-cancer hematologic conditions.

Bottom Line: 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).Further evaluations using medical chart abstractions or registries will be valuable.

View Article: PubMed Central - HTML - PubMed

Affiliation: Optum, Eden Prairie, MN, USA ; Health Economics and Outcomes Research, Optum, 12125 Technology Drive, Eden Prairie, MN 53344, USA.

ABSTRACT

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.

No MeSH data available.


Related in: MedlinePlus