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Open Access Research article

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

Nicole M Engel-Nitz16*, Benjamin Eckert23, Rui Song1, Priyanka Koka1, Erin M Hulbert1, Jeffrey McPheeters1 and April Teitelbaum145

Author Affiliations

1 Optum, Eden Prairie, MN, USA

2 Novartis Molecular Diagnostics, Cambridge, MA, USA

3 Present address Metamark Genetics, Cambridge, MA, USA

4 Present address Heme Onc Associates, Carlsbad, CA, USA

5 AHT BioPharma Advisory Services, Carlsbad, CA, USA

6 Health Economics and Outcomes Research, Optum, 12125 Technology Drive, Eden Prairie, MN 53344, USA

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BMC Clinical Pathology 2014, 14:17  doi:10.1186/1472-6890-14-17

Published: 27 April 2014

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.

Keywords:
Diagnostic laboratory tests; Diagnostic costs; Hematopathology; Leukemia; Lymphoma