Dlamini Immaculate S, Gounden Verena, Moodley Nareshni
Department of Chemical Pathology, Faculty of Laboratory Medicine, National Health Laboratory Service, Durban, South Africa.
Department of Chemical Pathology, Faculty of Laboratory Medicine, University of KwaZulu-Natal, Durban, South Africa.
Afr J Lab Med. 2023 Jun 30;12(1):2027. doi: 10.4102/ajlm.v12i1.2027. eCollection 2023.
Inappropriate testing remains a high healthcare cost driver. Tumour marker tests are more expensive than routine chemistry testing. Implementing test demand management systems like electronic gatekeeping (EGK) has reportedly decreased test requests.
This study aimed to describe the appropriateness of tumour marker tests, carcinoembryonic antigen, alpha foetal protein, prostate-specific antigen, carbohydrate antigen 19-9, cancer antigen 15-3, cancer antigen 125, and human chorionic gonadotropin, and determine the effectiveness of the EGK used in the public health sector in KwaZulu-Natal, South Africa.
Tumour marker test data for the KwaZulu-Natal province were extracted from the National Health Laboratory Service Central Data Warehouse for 01 January 2017 - 30 June 2017 (pre-EGK) and 01 January 2018 - 30 June 2018 (post-EGK implementation). Questionnaires were sent to the clinicians in the regional hospitals ordering the most tumour marker tests to assess ordering practices. In addition, we assessed monthly rejection reports to determine the effect of the EGK.
The EGK minimally reduced tumour marker requests or associated costs (1.4% average EGK rejection rate). An overall 18% increase in the tumour marker tests occurred in 2018. The data suggest inappropriate tumour marker test utilisation, particularly for screening.
The introduction of EGK as a test demand management had little impact on tumour marker test requests and costs. Continuous education and reiteration of indications for tumour marker test use are required.
This study demonstrates the ineffectiveness of EGK in tumour marker orders, and provides some insight as to why these markers are being ordered, which is important in trying to decrease inappropriate ordering of these tests.
不恰当的检测仍是医疗成本居高不下的一个因素。肿瘤标志物检测比常规化学检测费用更高。据报道，实施诸如电子把关（EGK）等检测需求管理系统可减少检测申请。
本研究旨在描述癌胚抗原、甲胎蛋白、前列腺特异性抗原、糖类抗原19-9、癌抗原15-3、癌抗原125和人绒毛膜促性腺激素等肿瘤标志物检测的恰当性，并确定南非夸祖鲁-纳塔尔省公共卫生部门使用的EGK的有效性。
从国家卫生实验室服务中心数据仓库提取夸祖鲁-纳塔尔省2017年1月1日至2017年6月30日（EGK实施前）和2018年1月1日至2018年6月30日（EGK实施后）的肿瘤标志物检测数据。向订购肿瘤标志物检测最多的地区医院的临床医生发送问卷，以评估订购行为。此外，我们评估每月的拒收报告以确定EGK的效果。
EGK对肿瘤标志物申请或相关成本的降低作用微乎其微（EGK平均拒收率为1.4%）。2018年肿瘤标志物检测总体增加了18%。数据表明肿瘤标志物检测存在不恰当使用的情况，尤其是在筛查方面。
引入EGK作为检测需求管理措施对肿瘤标志物检测申请和成本影响不大。需要持续开展教育并反复强调肿瘤标志物检测的适用情况。
本研究证明了EGK在肿瘤标志物订单方面无效，并对这些标志物被订购的原因提供了一些见解，这对于试图减少这些检测的不恰当订购很重要。
