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Clinical Chemistry and Laboratory Medicine (CCLM)

Published in Association with the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)

Editor-in-Chief: Plebani, Mario

Ed. by Gillery, Philippe / Lackner, Karl J. / Lippi, Giuseppe / Melichar, Bohuslav / Payne, Deborah A. / Schlattmann, Peter / Tate, Jillian R.

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Economic evidence in decision-making process in laboratory medicine

Massimo Brunetti1 / Silvia Pregno2 / Holger Schünemann3 / Mario Plebani4 / 1

1Patologia Clinica, Tossicologia e Diagnostica Avanzata, Nuovo Ospedale S. Agostino Estense, Modena, Italy

2Public Health Physicians Modena, Modena, Italy

3Department of Clinical Epidemiology and Biostatistics, McMaster University Hamilton, Hamilton, Canada

4Dipartimento Medicina di Laboratorio, Azienda Ospedaliera – Università di Padova, Padova, Italy

Corresponding author: Tommaso Trenti, Patologia Clinica, Tossicologia e Diagnostica Avanzata, Nuovo Ospedale S. Agostino Estense, via Giardini 1355, Modena, Italy Phone: +390593961467, Fax: +390593961249

Citation Information: Clinical Chemistry and Laboratory Medicine. Volume 49, Issue 4, Pages 617–621, ISSN (Online) 1437-4331, ISSN (Print) 1434-6621, DOI: 10.1515/CCLM.2011.119, March 2011

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Laboratory data play a pivotal role in the clinical decision-making process. Major transformations have occurred in laboratory medicine in recent decades. To face the economic pressures, hospital laboratories are forced to enhance efficiency. Decisions on policy and practice take place at many levels. However, decision-making often does not follow Evidence Based Laboratory Medicine principles. Also, the literature shows limited influence of economic evaluations on health care decisions and diagnostic processes. Several barriers to the use of economic evaluation in decision-making process have been identified, and guidelines tend to focus on issues of effectiveness and have not explicitly considered broader issues, particularly cost. As an example, we analyzed recommendations on the use of brain natriuretic peptide (BNP) or N-terminal fragment of the prohormone BNP (NT-proBNP) in patients with chronic heart failure. All guidelines recommend the use of BNP if available. Nevertheless, none included economic data explicitly, even if economic information exists in the literature. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group, propose using a balance sheet approach, one way of helping decision makers to explicitly consider resource use along with other outcomes when making recommendations. Key aspects of GRADE, such as the explicit presentation of information and the quality evaluation of the economic data can help overcome barriers in the use of economic evaluations in the decision-making in process. This approach can help to give health decision makers, clinical guideline panels and patients, a better appreciation of the overall health benefits, harms and costs of laboratory tests.

Keywords: appropriateness; costs; economic evidence; guidelines; laboratory medicine; recommendations

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Clinical Chemistry and Laboratory Medicine, 2011, Volume 49, Number 10

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