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Magnitude of Potentially Inappropriate Thrombophilia Testing in the Inpatient Hospital Setting
Eric Mou1, Henry Kwang2, Jason Hom2
1Department of Medicine, Stanford University, Stanford, California, USA. emou@stanford.edu.
Insights
Potentially inappropriate thrombophilia testing is common in hospitals, costing over $40,000 in just two years. Implementing institutional changes can reduce unnecessary spending and improve patient care.
Area of Science:
- Medical Economics
- Clinical Pathology
- Healthcare Management
Background:
- Thrombophilia testing laboratory costs exceed $650 million annually in the US.
- Reducing healthcare expenditures requires quantifying inappropriate testing in hospitals.
- Inpatient thrombophilia testing prevalence and financial impact are not well-defined.
Purpose of the Study:
- To evaluate the prevalence and financial impact of potentially inappropriate inpatient thrombophilia testing.
- To identify specific thrombophilia tests frequently ordered inappropriately.
- To provide data supporting the need for changes in testing protocols.
Main Methods:
- Retrospective analysis of electronic medical records for inpatient thrombophilia testing over two years.
- Evaluation of test appropriateness against preformulated criteria.
- Cost data acquisition from the 2016 CMS Clinical Laboratory Fee Schedule.
Main Results:
- Analysis of 1817 orders revealed 777 (42.7%) were potentially inappropriate.
- Associated costs for inappropriate testing amounted to $40,422.
- Most frequently inappropriate tests included Factor V Leiden, prothrombin gene mutation, protein C and S activity, antithrombin activity, and lupus anticoagulant.
Conclusions:
- Potentially inappropriate thrombophilia testing is prevalent in the inpatient setting.
- Unnecessary testing incurs significant financial costs.
- Institution-wide changes are needed to reduce expenditures and enhance patient care.
Abstract:
Laboratory costs of thrombophilia testing exceed an estimated $650 million (in US dollars) annually. Quantifying the prevalence and financial impact of potentially inappropriate testing in the inpatient hospital setting represents an integral component of the effort to reduce healthcare expenditures. We conducted a retrospective analysis of our electronic medical record to evaluate 2 years' worth of inpatient thrombophilia testing measured against preformulated appropriateness criteria. Cost data were obtained from the Centers for Medicare and Medicaid Services 2016 Clinical Laboratory Fee Schedule. Of the 1817 orders analyzed, 777 (42.7%) were potentially inappropriate, with an associated cost of $40,422. The tests most frequently inappropriately ordered were Factor V Leiden, prothrombin gene mutation, protein C and S activity levels, antithrombin activity levels, and the lupus anticoagulant. Potentially inappropriate thrombophilia testing is common and costly. These data demonstrate a need for institution-wide changes in order to reduce unnecessary expenditures and improve patient care.
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