Assessing the cost-effectiveness of a routine versus an extensive laboratory work-up in the diagnosis of anaemia in Dutch general practice

Abstract

BackgroundEstablishing the underlying cause of anaemia in general practice is a diagnostic challenge. Currently, general practitioners individually determine which laboratory tests to request (routine work-up) in order to diagnose the underlying cause. However, an extensive work-up (consisting of 14 tests) increases the proportion of patients correctly diagnosed. This study investigates the cost-effectiveness of this extensive work-up.MethodsA decision-analytic model was developed, incorporating all societal costs from the moment a patient presents to a general practitioner with symptoms suggestive of anaemia (aged ≥ 50 years), until the patient was (correctly) diagnosed and treated in primary care, or referred to (and diagnosed in) secondary care. Model inputs were derived from an online survey among general practitioners, expert estimates and published data. The primary outcome measure was expressed as incremental cost per additional patient diagnosed with the correct underlying cause of anaemia in either work-up.ResultsThe probability of general practitioners diagnosing the correct underlying cause increased from 49.6% (95% CI: 44.8% to 54.5%) in the routine work-up to 56.0% (95% CI: 51.2% to 60.8%) in the extensive work-up (i.e. +6.4% [95% CI: −0.6% to 13.1%]). Costs are expected to increase slightly from €842/patient (95% CI: €704 to €994) to €845/patient (95% CI: €711 to €994), i.e. +€3/patient (95% CI: €−35 to €40) in the extensive work-up, indicating incremental costs of €43 per additional patient correctly diagnosed.ConclusionsThe extensive laboratory work-up is more effective for diagnosing the underlying cause of anaemia by general practitioners, at a minimal increase in costs. As accompanying benefits in terms of quality of life and reduced productivity losses could not be captured in this analysis, the extensive work-up is likely cost-effective.

A new diagnostic work-up for defining anemia etiologies: a cohort study in patients ≥ 50 years in general practices

“…This will reduce the number of missed causes of anemia and creates an optimal treatment framework. Furthermore, the laboratory protocol used for this study has shown to be effective at a minimal increase in costs [8]. In conclusion, an extensive laboratory analysis should be a standard first step during the diagnostic work-up of a newly diagnosed anemia patient, independently of the clinical presentation.…”

“…They found that an extensive laboratory analysis leads more often to establishment of the anemia etiology [7]. Moreover, extensive laboratory analysis would prevent a delay in the initiation of treatment for the underlying disease and has shown to be cost-effective [8]. Another drawback of a limited or step-wise laboratory analysis is that this cannot assess the multifactorial role of etiologies causing anemia.…”

A new diagnostic work-up for defining anemia etiologies: a cohort study in patients ≥ 50 years in general practices

“…This will reduce the number of missed causes of anemia and creates an optimal treatment framework. Furthermore, the laboratory protocol used for this study has shown to be effective at a minimal increase in costs [8]. In conclusion, an extensive laboratory analysis should be a standard rst step during the diagnostic work-up of a newly diagnosed anemia patient, independently of the clinical presentation.…”

“…They found that an extensive laboratory analysis leads more often to establishment of the anemia etiology [7]. Moreover, extensive laboratory analysis would prevent a delay in the initiation of treatment for the underlying disease and has shown to be costeffective [8]. Another drawback of a limited or step-wise laboratory analysis is that this cannot assess the multifactorial role of etiologies causing anemia.…”

A new diagnostic work-up for defining anemia etiologies: a cohort study in general practices

“…Recent evidence, however, shows that in general practice the use of a limited laboratory analysis less often than a more extensive laboratory analysis leads to establishing the anemia etiology [7]. Moreover, extensive laboratory analysis would prevent a delay in the initiation of treatment for the underlying disease and has shown to be costeffective [8]. Another drawback of a limited or step-wise laboratory analysis is that this cannot assess the multifactorial role of etiologies causing anemia.…”