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2017, Cilt 15, Sayı 2, Sayfa(lar) 067-074
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"Reflex Test" Implementation on Thyroid Function Test Requests and Examination of the Effect on Health Expenditures
Ferhat Demirci1, İnanç Karakoyun2, Can Duman2, Fatma Demet Arslan2, Defne Özbek1, Dilek Kalenci1
1Dr. Suat Seren Göğüs Hastalıkları ve Cerrahisi Eğitim Araştırma Hastanesi, Tıbbi Biyokimya Laboratuvarı, İzmir, Türkiye
2Tepecik Eğitim Araştırma Hastanesi, Tıbbi Biyokimya Kliniği, İzmir, Türkiye
Keywords: Cost-benefit analysis, Thyroid gland function tests, Diagnoses and laboratory examinations

Objective: Thyroid function tests (TFT) are the most frequently requested endocrine tests from clinical laboratories. Although the guidelines published by the American and British Thyroid Associations suggest the use of thyroid stimulating hormone (TSH) as a first step test for thyroid diseases, algorithms for these tests are not considered. In our study, we aimed to investigate the effect of health expenditure of the TFT reflex test application which we initiated in our hospital.

Material and Methods: The request of at least one of the free triiodothyronine or free tetraiodothyronine tests in addition to the TSH test in euthyroid patients was also considered unnecessary test. Cost analysis of unnecessary tests was performed six months before and six months after the reflex test application. The change in unnecessary test request rates was assessed by the "significance test of the difference between the two percent".

Results: After the implementation, unnecessary test for all outpatient clinics decreased from 40,65% to 1,19% (p <0.001). The unnecessary test rate from internal medicine clinics decreased from 27,4% to 0,86% (p <0.001), while the other clinics’ rate decreased from 52,18% to 1,54% (p <0.001). With the cost analysis made, the unnecessary test request cost was reduced from 38.384,50 TL to 657 TL by the implementation of reflex test for six months.

Conclusion: Too much testing do not always mean that we will get clinically compatible results; contrarily, it prevents cost-effective work and also leads to false diagnostic and clinically incompatible results. The reflex test which is defined according to various guides and algorithms by hospitals, clinicians and laboratorians have positive effects on health care system due to its cost effectiveness as we have shown. Therefore the use of other reflex tests and algorithms keep our interest on this topic as laboratory professionals.

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