Takemura Y, Ishida H, Inoue Y, Beck J R
Department of Pathology and Information Technology Program, Baylor College of Medicine, Houston, TX 77030-3498, USA.
Clin Chem. 1999 Oct;45(10):1752-61.
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.
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.
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 yen1251 ( approximately $10) to yen23 037 ( approximately $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.
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.
日本临床病理学会（JSCP）制定了一项针对新初级保健门诊患者常见诊断检查应用的指南。为确定JSCP检验组合系统的科学和经济有效性，我们分析了所倡导的检验组合的成本效益参数。
“基本实验室检查”组合（2）[ELT（2）组合]，即在ELT（1）基线健康状况筛查组合基础上增加的一组常见诊断检查，应用于1991年至1997年期间到一所学术医疗中心综合内科门诊就诊的540名新患者。检验的“有用结果”（UR）定义为一项检查结果，该结果导致医生对仅通过病史和体格检查得出的“初步暂定诊断”（TID）的诊断或决策发生改变。
ELT（2）在259名患者中显示出临床实用性，这些患者产生了398个有用结果。临床有效性（UR/TID）范围从1.65（血液学）到0.088（神经疾病），每个有用结果的成本差异从1251日元（约10美元）到23037日元（约200美元）。总共1137项检查产生了有用结果。我们进一步评估了ELT（1）和重新构建的组合的临床有效性和经济效率（成本/UR）。单独使用ELT（1）在167名患者中产生了244个有用结果。通过在肝脏/胰腺胆管、代谢/内分泌和心血管疾病组中添加某些特定于ELT（2）的检查，ELT（1）组合的低效情况得到了显著改善。
ELT组合在不同患者群体中的效用存在很大差异，这并不支持JSCP关于将其常规用于新门诊患者的建议。应在特定患者群体中使用选择性的检查组合。
