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1
Department of Pathology and Information Technology Program, Baylor College of Medicine, Houston, TX 77030-3498.
2
Department of Clinical Pathology, Kawasaki Medical
School, Kurashiki, Okayama 701-0192, Japan.
3
Department of Medical Informatics, Yamaguchi University
School of Medicine, Ube, Yamaguchi 755-8505, Japan.
4
Department of Laboratory Medicine, National Defense
Medical College, Tokorozawa, Saitama 359-8513, Japan.
a Address correspondence to this author at: Department of Pathology and Information Technology, Baylor College of Medicine, One Baylor Plaza, Room 126E, Texas Medical Center, Houston, TX 77030-3498. Fax 713-790-7052; e-mail takemura{at}bcm.tmc.edu
Background: The Japan Society of Clinical Pathology (JSCP) has developed a guideline for common diagnostic test utilization in new primary care outpatients. To determine the scientific and economic validity of the JSCP panel testing system, we analyzed cost-effectiveness parameters of test panels advocated.
Methods: The "Essential Laboratory Tests" panel (2) [ELT(2) panel], a package of common diagnostic tests added to the ELT(1) baseline health-status screening panel, was applied to 540 new outpatients who visited the Comprehensive Medicine Clinics in an academic medical center during 1991 to 1997. A "useful result" (UR) of testing was defined as a finding that contributed to a change in a physician's diagnosis- or decision-making, relating to a "tentative initial diagnosis" (TID) obtained from history and physical examination alone.
Results: Clinical usefulness was demonstrated in 259 patients with ELT(2), in whom 398 URs were generated. Clinical effectiveness (UR/TID) ranged from 1.65 (hematological) to 0.088 (neurological disease), with a cost disparity from ¥1251 (~$10) to ¥23 037 (~$200) per UR. A total of 1137 tests generated URs. We further assessed the clinical effectiveness and economic efficiency (cost/UR) of ELT(1) and restructured panels. Use of the ELT(1) alone generated 244 URs in 167 patients. The poor efficiency of the ELT(1) panel was markedly improved with the addition of certain ELT(2)-specific tests in liver/pancreatobiliary, metabolic/endocrine, and cardiovascular disease groups.
Conclusions: A wide disparity in the utility of ELT panels in different patient groups does not support the JSCP recommendation of their routine use for new outpatients. Selective test combinations should be used in selected patient groups.
The following articles in journals at HighWire Press have cited this article:
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  Y Takemura, K Ebisawa, H Kakoi, H Saitoh, H Kure, H Ishida, and M Kure Antibiotic selection patterns in acutely febrile new outpatients with or without immediate testing for C reactive protein and leucocyte count J. Clin. Pathol., July 1, 2005; 58(7): 729 - 733. [Abstract] [Full Text] [PDF]
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 Y. Takemura, H. Kakoi, H. Ishida, H. Kure, Y. Tatsuguchi-Harada, M. Sugawara, Y. Inoue, K. Ebisawa, and M. Kure Immediate Availability of C-Reactive Protein and Leukocyte Count Data Influenced Physicians' Decisions to Prescribe Antimicrobial Drugs for New Outpatients with Acute Infections Clin. Chem., January 1, 2004; 50(1): 241 - 244. [Full Text] [PDF]
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Y. Takemura, H. Ishida, Y. Inoue, and J. R. Beck Yield and Cost of Individual Common Diagnostic Tests in New Primary Care Outpatients in Japan Clin. Chem., January 1, 2002; 48(1): 42 - 54. [Abstract] [Full Text] [PDF]
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Y Takemura and J R Beck Laboratory testing under managed care dominance in the USA J. Clin. Pathol., February 1, 2001; 54(2): 89 - 95. [Abstract] [Full Text] [PDF]
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Y. Takemura, H. Ishida, Y. Inoue, H. Kobayashi, and J. R. Beck Opportunistic Discovery of Occult Disease by Use of Test Panels in New, Symptomatic Primary Care Outpatients: Yield and Cost of Case Finding Clin. Chem., August 1, 2000; 46(8): 1091 - 1098. [Abstract] [Full Text] [PDF]
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