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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

Distribution of bone marrow biopsies received per patient and by laboratory.
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Figure 2: Distribution of bone marrow biopsies received per patient and by laboratory.

Mentions: The number of tests (Table 2) varied across the 1-year follow-up period. The distribution of BM biopsies was skewed with the majority of patients receiving 1 BM (Figure 2). The LL cohort had the fewest total tests and the GX and OL cohorts appearing more similar (Table 2). The average time to final diagnosis differed across the cohorts, ranging from 36 days for GX to 41 days for OL (marginal difference, p = 0.051). The median time to final diagnosis was roughly 2 weeks, with the OL cohort having a shorter time by 2 days. The Cox proportional model hazard ratios (reference group OL cohort) of reaching a final diagnosis by any point in time within the initial 30-day testing period were 1.002 (p = 0.0029) for the GX cohort and 0.95 for the LL cohort (p = 0.0002). However, at any point in time during the post-30 day testing period, the GX cohort had a roughly 23% higher hazard than the OL cohort of having reached a final diagnosis by that point (HR = 1.23, p = 0.0007), and the LL cohort had a roughly 10% higher hazard of having reached a final diagnosis at any given point in time (HR = 1.10, p = 0.005). Substantially fewer GX patients underwent repeat marrow biopsies (Table 2; 9.59% GX, vs. 17.11% LL, and 28.16% OL, p < 0.001), with differences remaining after adjusting for type of hematologic malignancy diagnosed and other characteristics (OR: GX 0.31 [0.26, 0.37]; LL 0.56 [0.51, 0.62]).


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)

Distribution of bone marrow biopsies received per patient and by laboratory.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Distribution of bone marrow biopsies received per patient and by laboratory.
Mentions: The number of tests (Table 2) varied across the 1-year follow-up period. The distribution of BM biopsies was skewed with the majority of patients receiving 1 BM (Figure 2). The LL cohort had the fewest total tests and the GX and OL cohorts appearing more similar (Table 2). The average time to final diagnosis differed across the cohorts, ranging from 36 days for GX to 41 days for OL (marginal difference, p = 0.051). The median time to final diagnosis was roughly 2 weeks, with the OL cohort having a shorter time by 2 days. The Cox proportional model hazard ratios (reference group OL cohort) of reaching a final diagnosis by any point in time within the initial 30-day testing period were 1.002 (p = 0.0029) for the GX cohort and 0.95 for the LL cohort (p = 0.0002). However, at any point in time during the post-30 day testing period, the GX cohort had a roughly 23% higher hazard than the OL cohort of having reached a final diagnosis by that point (HR = 1.23, p = 0.0007), and the LL cohort had a roughly 10% higher hazard of having reached a final diagnosis at any given point in time (HR = 1.10, p = 0.005). Substantially fewer GX patients underwent repeat marrow biopsies (Table 2; 9.59% GX, vs. 17.11% LL, and 28.16% OL, p < 0.001), with differences remaining after adjusting for type of hematologic malignancy diagnosed and other characteristics (OR: GX 0.31 [0.26, 0.37]; LL 0.56 [0.51, 0.62]).

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