Melanson Stacy E F, Petrides Athena K
Department of Pathology, Brigham and Women's Hospital, Boston, MA.
Division of Clinical Laboratories, Harvard Medical School, Boston, MA.
J Appl Lab Med. 2018 Jan 1;2(4):587-597. doi: 10.1373/jalm.2017.023010.
Chronic pain management accounts for a significant portion of health-care costs and has important societal implications, including the increasing availability of prescription narcotics. Urine drug testing (UDT) is an effective tool to monitor adherence to prescription medications and has been recommended by several guidelines. Furthermore, the clinical and technical benefits of UDT using definitive testing methods such as LC-MS/MS are well documented. However, the cost-effectiveness is not well studied.
In this article, we discuss the cost considerations associated with different UDT methodologies, including point-of-care immunoassays, laboratory-based immunoassays, and definitive testing by LC-MS/MS. The costs of reagents, consumables, instrumentation, service, and labor are described, as well as the opportunity each methodology offers in relation to test utilization and clinical cost savings. An overview of how to assess the cost-effectiveness of insourcing definitive testing and how to generate a comprehensive insourcing proposal is provided. Billing options for UDT and the recent changes in current procedural terminology codes are also discussed.
Given the current health-care environment, additional studies and recommendations that incorporate the cost-effectiveness of definitive testing to monitor compliance in pain management are needed. The decreasing cost of mass spectrometry, the increasing visibility of the value of the laboratory medicine, the new prescriber regulations for opioids, and the push to change reimbursement for definitive UDT will all contribute to the cost-effectiveness of definitive LC-MS/MS to monitor patients with chronic pain.
慢性疼痛管理占医疗保健成本的很大一部分，并具有重要的社会影响，包括处方麻醉药品的可获得性增加。尿液药物检测（UDT）是监测患者对处方药依从性的有效工具，并且已被多项指南推荐。此外，使用诸如液相色谱 - 串联质谱法（LC-MS/MS）等确定性检测方法进行UDT的临床和技术优势已有充分记录。然而，其成本效益尚未得到充分研究。
在本文中，我们讨论了与不同UDT方法相关的成本考量，包括即时检验免疫测定法、基于实验室的免疫测定法以及通过LC-MS/MS进行的确定性检测。描述了试剂、耗材、仪器、服务和人工成本，以及每种方法在检测利用和临床成本节约方面提供的机会。提供了如何评估内部进行确定性检测的成本效益以及如何生成全面的内部实施方案的概述。还讨论了UDT的计费选项以及当前程序术语代码的最新变化。
鉴于当前的医疗保健环境，需要开展更多纳入确定性检测成本效益以监测疼痛管理依从性的研究并提出建议。质谱分析成本的降低、检验医学价值的日益凸显、阿片类药物新的处方规定以及改变确定性UDT报销方式的推动，都将有助于通过确定性LC-MS/MS监测慢性疼痛患者的成本效益。
