Abstract
BackgroundSuccessful management of patients with hematologic malignancies depends upon accurate and timely diagnosis, which frequently requires integration and interpretation of multiple tests. Our retrospective analysis compared diagnostic uncertainty, resource utilization, and costs for patients with diagnostic bone marrow (BM) tests managed by commercial laboratories.MethodsPatients with BM biopsies and suspected hematologic cancer/condition were identified from claims (2005–2011) within a large US health plan (coverage ≥6 pre- and ≥3-months post-biopsy). Cohorts defined by laboratories performing BM morphologic assessment/directing testing sequence: Genoptix (GX, specialty hematology-testing laboratory), large commercial laboratories (LL), other laboratories (OL). One-year post-biopsy changes in diagnosis or treatments, tests performed, and diagnostic/treatment medical costs (measured as per-patient-per-month [PPPM]) were examined.ResultsThe study population included 1,387 GX, 4,162 LL, and 19,115 OL patients with suspected hematologic malignancy/disease and BM morphology assessment. GX had lower diagnostic uncertainty measured between 2 time periods by diagnostic stability (no conditions the same; 6.16% GX, 8.04% LL, 9.73% OL; p < 0.001) and changes (≥1 condition different; 7.88% GX, 11.19% LL, and 14.08% OL; p < 0.001), fewer repeat BM biopsies, and fewer chemotherapy changes (30-days and 60-days post-initiation). One-year PPPM costs adjusted for patient characteristics differences were $8,202 GX, $7,711 LL, and $10,302 OL (p < 0.05); adjusted PPPM costs (excluding testing period) were $6,019 GX, $6,649 LL, and $7,801 OL (p < 0.05).ConclusionsOur data suggests that a hematopathology specialty laboratory may result in earlier final diagnosis, fewer subsequent diagnosis changes, reduced need for follow-on testing requiring repeat biopsy procedures, and may result in lower downstream healthcare costs. Further evaluations using medical chart abstractions or registries will be valuable.
Highlights
Successful management of patients with hematologic malignancies depends upon accurate and timely diagnosis, which frequently requires integration and interpretation of multiple tests
Patients with non-hematologic cancer and any other non-hematologic condition listed as the diagnoses on their bone marrow biopsy claims were removed from
Population characteristics of the Genoptix and large commercial laboratories (LL) cohorts differed from the other laboratories (OL), including initial suspected diagnosis listed on the bone marrow biopsy
Summary
Successful management of patients with hematologic malignancies depends upon accurate and timely diagnosis, which frequently requires integration and interpretation of multiple tests. Seeking to improve diagnostic accuracy for hematologic cancers, updated diagnostic guidelines have incorporated advances in diagnostic testing, including molecular profiling [6,7,8]. The complexity of diagnosing hematologic malignancies has intensified with development of sophisticated laboratory tests as new molecular markers are identified. These markers are used to diagnose disease subtypes, as well as prognostic risk which impact treatment selection and disease monitoring [9,10]
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