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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

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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
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Silvia Pregno / Holger Schünemann
  • Department of Clinical Epidemiology and Biostatistics, McMaster University Hamilton, Hamilton, Canada
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Mario Plebani
  • Dipartimento Medicina di Laboratorio, Azienda Ospedaliera – Università di Padova, Padova, Italy
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Tommaso Trenti
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.

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©2011 by Walter de Gruyter Berlin New York. Copyright Clearance Center

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