ABSTRACT
BACKGROUND: The inappropriate use of tumour markers (TMs) is a common problem. The aim of this audit was to evaluate the impact of local guidelines on the TM requesting patterns of a General Surgery Department. METHODS: CA 125, CA 19-9, CA15-3, CEA, AFP and HCG requests from all hospital surgical locations were audited over two periods of eight months before and after the implementation of local requesting guidelines. RESULTS: Postintervention, total TM requests decreased by 32% while patient requests decreased by 9.8%. Single TM requesting increased and requests for panels containing four or more TMs decreased from 279 to 60 requests (78% reduction). CONCLUSION: Interdepartmental collaboration and the implementation of local guidelines have resulted in a change in requesting behaviour, most notably a reduction in multiple TM panel requests.
Subject(s)
Biomarkers, Tumor/analysis , Guideline Adherence/organization & administration , Hospitals, University , Practice Guidelines as Topic , Total Quality Management/organization & administration , Biomarkers, Tumor/economics , CA-125 Antigen/analysis , CA-125 Antigen/economics , CA-19-9 Antigen/analysis , CA-19-9 Antigen/economics , Carcinoembryonic Antigen/analysis , Carcinoembryonic Antigen/economics , Chorionic Gonadotropin/analysis , Chorionic Gonadotropin/economics , General Surgery , Humans , Medical Audit/ethics , Medical Audit/statistics & numerical data , Mucin-1/analysis , Mucin-1/economics , alpha-Fetoproteins/analysis , alpha-Fetoproteins/economicsABSTRACT
INTRODUCTION: Several international organizations have published guidelines for the correct use of tumour markers in clinical practice. However, there are reports that clinicians do not adhere to these guidelines in clinical practice. The present study constitutes an audit of TM use in a major hospital in Northern Greece. Purpose of our study is to quantify the magnitude of inappropriate TM requests as well as the corresponding financial cost. METHODS: We examined retrospectively all TM requests between 10/2006 and 07/2007 in the department of biochemistry of our hospital. The tumour markers included in our study were: CA 19-9, CA 125, CA 15-3, AFP, NSE, CYFRA 21-1 and CEA. RESULTS: We found 9782 inappropriate TM orders. For five of them - namely CA 125, AFP, CA 19-9, CYFRA 21-1 and NSE - the proper requests were below 10%. There were 5.6 TM requests per patient. The total cost for inappropriate TM reached 239,748 euro, which corresponds to a monthly cost of 23,974euro. CONCLUSIONS: There is considerable inappropriateness in the utilization of TM in Greece which corresponds to significant financial cost. Various measures should be applied in order to increase the cost-effectiveness of TM use.
Subject(s)
Biomarkers, Tumor/economics , Health Care Costs , Medical Audit , Neoplasms/diagnosis , Neoplasms/economics , Adult , Aged , Aged, 80 and over , Antigens, Neoplasm/economics , CA-125 Antigen/economics , CA-19-9 Antigen/economics , Carcinoembryonic Antigen/economics , Cost-Benefit Analysis , Female , Greece , Humans , Keratin-19/economics , Male , Middle Aged , Mucin-1/economics , Phosphopyruvate Hydratase/economics , Practice Guidelines as Topic , Retrospective Studies , Young Adult , alpha-Fetoproteins/economicsABSTRACT
OBJECTIVE: Appreciate medical practice concerning CA 15.3 indications. MATERIAL AND METHOD: Starting with dosages reimbursed to people on social security, the health service near the primary Health care assurance offices (caisse primaire d'assurance maladie) at Roubaix, conducted a study over a period of 3 months, in which they asked physicians for their reasons for prescribing CA 15.3. RESULTS: Of the 205 questionnaires at their disposal, only 58 prescriptions conformed to the guidelines (28.3%). Prescriptions from specialists conformed in 48.9% of cases, as opposed to 12.8% from general practitioners. DISCUSSION AND CONCLUSION: The estimated assessment of the immediate additional expenditure will be shown to be 4 million Euros a year, over the whole of France.
