Optimizing antiphospholipid antibody testing: a real-world analysis of appropriateness and resource utilization

Area of Science:

• Clinical Immunology
• Healthcare Management
• Diagnostic Laboratory Medicine

Background:

• Efficient healthcare resource utilization is vital for sustainability and cost-effectiveness.
• Antiphospholipid syndrome (APS) diagnosis requires clinical events and antiphospholipid antibody (aPL) detection.
• Inappropriate aPL test requests lead to increased healthcare expenses and environmental burden.

Purpose of the Study:

• To evaluate the appropriateness of antiphospholipid antibody (aPL) testing in a clinical setting.
• To identify patterns of inappropriate aPL test requests across different medical specialties.
• To assess the impact of inappropriate testing on healthcare costs and resource utilization.

Main Methods:

• Retrospective analysis of 642 patient test requests at San Giovanni Di Dio Hospital (11/2023-02/2024).
• Classification of diagnostic suspicion as appropriate, inappropriate, or unevaluable using a scoring system based on clinical recommendations.
• Analysis of patient demographics, test results, and ordering physician specialty.

Main Results:

• 36% of aPL test requests were appropriate, 42% inappropriate, and 22% unevaluable.
• Family physicians made 53% of requests with the highest inappropriate rate (44%).
• Only 4.9% of patients met international standards for comprehensive aPL testing; inappropriate requests often lacked clinical justification.

Conclusions:

• A significant proportion of aPL testing lacks clinical justification, indicating variability in guideline adherence.
• Inappropriate testing contributes to increased healthcare costs, specialist referrals, and environmental impact.
• Improved physician education and adherence to diagnostic recommendations are essential for optimizing aPL testing and resource use.