Evidence map›Paper›PMID 24817828›Full record

ArticleBMC clinical pathology2014

Diagnostic testing managed by hematopathology specialty and other laboratories: costs and patient diagnostic outcomes.

Nicole M Engel-Nitz, Benjamin Eckert, Rui Song, Priyanka Koka, Erin M Hulbert, Jeffrey McPheeters, April Teitelbaum

Open access · hybridAbstract read
In one paragraph

Article in BMC clinical pathology, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
0.6field-weighted citation impact, top 27% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 6 citations in OpenAlex.

  1. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 2 institutions in 1 country.

Nicole M Engel-NitzOptum, Eden Prairie, MN, USA ; Health Economics and Outcomes Research, Optum, 12125 Technology Drive, Eden Prairie, MN 53344, USA.
Benjamin EckertNovartis Molecular Diagnostics, Cambridge, MA, USA ; Present address Metamark Genetics, Cambridge, MA, USA.
Rui SongOptum, Eden Prairie, MN, USA.
Priyanka KokaOptum, Eden Prairie, MN, USA.
Erin M HulbertOptum, Eden Prairie, MN, USA.
Jeffrey McPheetersOptum, Eden Prairie, MN, USA.
April TeitelbaumOptum, Eden Prairie, MN, USA ; Present address Heme Onc Associates, Carlsbad, CA, USA ; AHT BioPharma Advisory Services, Carlsbad, CA, USA.
Optum (United States) · USNovartis (United States) · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundSuccessful management of patients with hematologic malignancies depends upon accurate and timely diagnosis, which frequently requires integration and interpretation of multiple tests. Our retrospective analysis compared diagnostic uncertainty, resource utilization, and costs for patients with diagnostic bone marrow (BM) tests managed by commercial laboratories.

methodsPatients with BM biopsies and suspected hematologic cancer/condition were identified from claims (2005-2011) within a large US health plan (coverage ≥6 pre- and ≥3-months post-biopsy). Cohorts defined by laboratories performing BM morphologic assessment/directing testing sequence: Genoptix (GX, specialty hematology-testing laboratory), large commercial laboratories (LL), other laboratories (OL). One-year post-biopsy changes in diagnosis or treatments, tests performed, and diagnostic/treatment medical costs (measured as per-patient-per-month [PPPM]) were examined.

resultsThe study population included 1,387 GX, 4,162 LL, and 19,115 OL patients with suspected hematologic malignancy/disease and BM morphology assessment. GX had lower diagnostic uncertainty measured between 2 time periods by diagnostic stability (no conditions the same; 6.16% GX, 8.04% LL, 9.73% OL; p < 0.001) and changes (≥1 condition different; 7.88% GX, 11.19% LL, and 14.08% OL; p < 0.001), fewer repeat BM biopsies, and fewer chemotherapy changes (30-days and 60-days post-initiation). One-year PPPM costs adjusted for patient characteristics differences were $8,202 GX, $7,711 LL, and $10,302 OL (p < 0.05); adjusted PPPM costs (excluding testing period) were $6,019 GX, $6,649 LL, and $7,801 OL (p < 0.05).

conclusionsOur data suggests that a hematopathology specialty laboratory may result in earlier final diagnosis, fewer subsequent diagnosis changes, reduced need for follow-on testing requiring repeat biopsy procedures, and may result in lower downstream healthcare costs. Further evaluations using medical chart abstractions or registries will be valuable.

Indexed as

Diagnostic costsDiagnostic laboratory testsHematopathologyLeukemiaLymphoma

Identifiers

PMID24817828
PMCPMC4016629
OpenAlexW2070633918

What OpenQuestion holds

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LicenceCC BY
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.