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Cost-Utility of Routine Testing in Chronic Urticaria/Angioedema: A Cohort Study
Ismael Carrillo-Martin1, Matthew G Dudgeon1, Natalia Chamorro-Pareja2
1Department of Medicine, Mayo Clinic, Jacksonville, Fla.
Insights
Routine diagnostic testing for chronic urticaria/angioedema (CUA) rarely changes patient outcomes or diagnoses. Limiting these tests can reduce the significant costs associated with CUA and improve care.
Area of Science:
- Dermatology
- Clinical Medicine
- Health Economics
Background:
- Chronic urticaria/angioedema (CUA) guidelines suggest limiting diagnostic tests.
- Routine testing may increase disease costs without improving patient outcomes.
Purpose of the Study:
- To evaluate the diagnostic utility and cost-effectiveness of tests used in CUA.
- To analyze trends in CUA testing from 2010 to 2018.
Main Methods:
- Retrospective review of 725 patient records evaluated for CUA between 2010-2018.
- Analysis of test utilization, diagnostic yield, impact on outcome, and associated costs.
Main Results:
- Over 74% of patients underwent at least one test, with >90% yielding normal results.
- Tests rarely led to changes in diagnosis (0.1%) or outcome (0.9%).
- Costs remained stable ($569 mean) between 2010-2014 and 2015-2018.
Conclusions:
- Diagnostic tests in CUA have limited value in uncovering conditions or altering management.
- Reducing unnecessary testing can decrease the financial burden of CUA and enhance care delivery.
Background:
Chronic urticaria/angioedema (CUA) guidelines recommend limiting tests to diagnose and assess prognosis, activity, and severity. Routine testing in CUA might substantially increase cost of disease without benefiting outcome.
Objective:
To evaluate the utility of tests in CUA and how they influence the cost of disease.
Methods:
We reviewed 725 electronic medical records of patients who were evaluated for CUA between 2010 and 2018 at a tertiary care center. The sample was gathered through the search of International Classification of Diseases Ninth and Tenth Revision codes pertaining to CUA. Analyses were made to evaluate changes in outcome for patients on whom at least 1 test was performed to evaluate CUA, the costs generated by these tests, and the tendencies to order specific tests from 2010 through 2018.
Results:
Of 725 patients (age median, 47 years; women, 73.1%), 543 (74.8%) had at least 1 test performed. Tests had an elevated percentage of normal results (>90%). Five patients (0.9%) had a change in outcome and 8 patients were given a different diagnosis (0.1% each). Evaluation, management, and tests accounted for most of the costs. Costs remain similar between 2010-2014 (mean, $569) and 2015-2018 (mean, $569).
Conclusions:
In CUA, tests rarely uncover underlying conditions or lead to changes in management and outcome, but they substantially increase the costs generated by the disease. Adherence to current recommendations to limit testing might help in reducing the financial burden of CUA and improve delivery of care.
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