HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (6) Citing Articles via Google Scholar Google Scholar Articles by Takemura, Y. Articles by Beck, J. R. Search for Related Content PubMed PubMed Citation Articles by Takemura, Y. Articles by Beck, J. R. Related Collections Evidence Based Laboratory Medicine and Test Utilization

Yield and Cost of Individual Common Diagnostic Tests in New Primary Care Outpatients in Japan

¹ Department of Laboratory Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan

² Department of Clinical Pathology, Kawasaki Medical School, Kurashiki, Okayama 701-0192, Japan

³ Department of Medical Informatics and Decision Sciences, Yamaguchi University School of Medicine, Ube, Yamaguchi 755-8505, Japan

⁴ Pathology/Information Technology Program, Baylor College of Medicine, Houston, TX 77030-3498

^aAuthor for correspondence. Fax 81-42-995-0633; e-mail yutakemu{at}interlink.or.jp.

Background:Appropriate diagnostic testing involves considerations of cost-effectiveness. We examined the cost-effectiveness of individual tests in a panel of tests defined by the Japan Society of Clinical Pathology.

Methods: We studied 540 new, symptomatic primary care outpatients with a set of 30 common diagnostic tests [the Essential Laboratory Tests (2); ELT(2) panel] for clinical evaluation and identification of occult disease. 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" obtained from history and physical examination alone.

Results: The ELT(2) panel testing yielded 398 URs and uncovered 261 occult diseases among 540 patients. In total, 1592 tests contributed to either UR-generation or discovery of occult disease. The cost per effective test (cost required per test that contributed to either definition of effectiveness) ranged from ¥108 (US$0.92) for total cholesterol to ¥6200 ($52.50) for chest x-ray. Contribution rates and the cost per effective test varied among disease categories. We restructured panel components considering the effectiveness of each test. Subsets of the ELT(2) would have improved cost-effectiveness and achieved cost savings in five of eight disease categories.

Conclusions: Assembly of tests based on cost-effectiveness can improve clinical efficiency and decrease total cost of panel testing for selected patient groups.

The following articles in journals at HighWire Press have cited this article:

				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]

				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]