Miyachi Hayato, Asai Satomi, Takemura Yuzuru
Department of Laboratory Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan.
Clin Chem Lab Med. 2006;44(8):1035-8. doi: 10.1515/CCLM.2006.187.
Although reticulocyte counts provide very useful information, few studies have analyzed the cost-effectiveness of this testing.
The yield and cost of reticulocyte count testing were analyzed in 719 new outpatients who visited the comprehensive medicine clinics and received both reticulocyte and complete blood count (CBC) testing. A "useful result" (UR) of the testing was defined as a finding that contributed to a change in a physician's diagnosis or decision-making between the pre- and post-test diagnosis. Patients' medical records were thoroughly reviewed for the assignment of URs. A simulation study was performed, blinding the reticulocyte data to the examiners, for the determination of URs generated by CBC alone.
CBC and reticulocyte testing generated a total of 838 URs in 719 patients, while the simulation study demonstrated 612 URs with CBC testing alone. When patients were grouped into 11 major disease categories according to a pre-test diagnosis, clinical effectiveness (UR/patient) varied from 1.69 (hematologic) to 0.13 (metabolic/endocrine patients), with a cost disparity from 206yen to 2784yen/UR. The cost-effectiveness (Deltacost/DeltaUR) of reticulocyte addition against CBC alone was 515yen per additional UR as a whole. Reticulocyte testing showed favorable cost-effectiveness in gastrointestinal ( 234yen) and hematologic patients ( 338yen/additional UR), while the test added few URs in metabolic/endocrine and neurologic patients, resulting in possibly unacceptable cost-effectiveness ( 3240yen and 2916yen/additional UR, respectively).
Wide disparity in its cost-effectiveness among patients apparently indicated that reticulocyte count testing should be performed for selected patient groups on the basis of its cost-effectiveness.
尽管网织红细胞计数能提供非常有用的信息，但很少有研究分析此项检测的成本效益。
对719名到综合内科门诊就诊并接受网织红细胞计数和全血细胞计数（CBC）检测的新门诊患者进行网织红细胞计数检测的产量和成本分析。检测的“有用结果”（UR）定义为有助于医生在检测前后诊断之间改变诊断或决策的结果。对患者的病历进行全面审查以确定UR。进行了一项模拟研究，对检查人员隐瞒网织红细胞数据，以确定仅通过CBC产生的UR。
CBC和网织红细胞检测在719名患者中总共产生了838个UR，而模拟研究表明仅CBC检测产生了612个UR。根据检测前诊断将患者分为11个主要疾病类别时，临床有效性（UR/患者）从1.69（血液学）到0.13（代谢/内分泌患者）不等，成本差异从206日元到2784日元/UR。相对于仅进行CBC，添加网织红细胞检测的成本效益（成本增量/UR增量）总体上为每个额外UR 515日元。网织红细胞检测在胃肠道（234日元）和血液学患者（338日元/额外UR）中显示出良好的成本效益，而该检测在代谢/内分泌和神经系统患者中产生的UR很少，导致成本效益可能无法接受（分别为3240日元和2916日元/额外UR）。
患者之间成本效益的巨大差异显然表明，应根据成本效益对选定的患者群体进行网织红细胞计数检测。
