Adoption of TSH Reflex algorithm in an Italian clinical laboratory

Area of Science:

• Clinical Chemistry
• Endocrinology
• Diagnostic Algorithms

Background:

• TSH Reflex is an automated diagnostic algorithm using a "If...then" rule.
• It involves initial TSH determination followed by fT4 and possibly fT3 if TSH is outside reference limits.
• The study evaluated the implementation of TSH Reflex at Grosseto hospital starting in late 2013.

Purpose of the Study:

• To evaluate the impact of the TSH Reflex test on thyroid hormone test requests.
• To assess changes in prescriptive appropriateness after TSH Reflex implementation.
• To calculate the financial savings resulting from the introduction of the TSH Reflex test.

Main Methods:

• Analysis of thyroid hormone test requests (TSH, fT4, fT3) in 2012, 2014, and 2015.
• Calculation of the prescription increase for TSH Reflex from 2014 to 2015.
• Evaluation of prescriptive appropriateness using TSH/FT4, TSH/FT3, and TSH Reflex/TSH ratios.
• Calculation of total reagent spending and savings in euros.

Main Results:

• TSH requests decreased by 9.8% (2015 vs 2012), FT4 by 16.2%, and FT3 by 20.6%.
• Prescriptive appropriateness (TSH/FT4 ratio) increased by 7.6% in 2014.
• Total spending decreased from €71,134 in 2012 to €60,055 in 2015, yielding savings of €11,079 (excluding TSH Reflex costs).

Conclusions:

• The TSH Reflex test improved efficiency and appropriateness, particularly in its first year (2014).
• Initial positive results in 2014 may be linked to communication with general practitioners.
• Further analysis is needed to assess long-term improvements and optimize the test's use.