Jump to ContentJump to Main Navigation
Show Summary Details

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.

12 Issues per year

IMPACT FACTOR increased in 2015: 3.017
Rank 5 out of 30 in category Medical Laboratory Technology in the 2014 Thomson Reuters Journal Citation Report/Science Edition

SCImago Journal Rank (SJR) 2015: 0.873
Source Normalized Impact per Paper (SNIP) 2015: 0.982
Impact per Publication (IPP) 2015: 2.238

See all formats and pricing
Volume 49, Issue 4 (Apr 2011)


Economic evidence in decision-making process in laboratory medicine

Massimo Brunetti
  • Patologia Clinica, Tossicologia e Diagnostica Avanzata, Nuovo Ospedale S. Agostino Estense, Modena, Italy
/ Silvia Pregno
  • Public Health Physicians Modena, Modena, Italy
/ Holger Schünemann
  • Department of Clinical Epidemiology and Biostatistics, McMaster University Hamilton, Hamilton, Canada
/ Mario Plebani
  • Dipartimento Medicina di Laboratorio, Azienda Ospedaliera – Università di Padova, Padova, Italy
/ Tommaso Trenti
  • Patologia Clinica, Tossicologia e Diagnostica Avanzata, Nuovo Ospedale S. Agostino Estense, Modena, Italy
  • Email:
Published Online: 2011-03-11 | DOI: https://doi.org/10.1515/CCLM.2011.119


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

About the article

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

Received: 2010-11-06

Accepted: 2010-12-17

Published Online: 2011-03-11

Published in Print: 2011-04-01

Citation Information: Clinical Chemistry and Laboratory Medicine, ISSN (Online) 1437-4331, ISSN (Print) 1434-6621, DOI: https://doi.org/10.1515/CCLM.2011.119. Export Citation

Citing Articles

Here you can find all Crossref-listed publications in which this article is cited. If you would like to receive automatic email messages as soon as this article is cited in other publications, simply activate the “Citation Alert” on the top of this page.

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

Comments (0)

Please log in or register to comment.
Log in