Photo by Phil Jones
A series of tests used to diagnose and monitor monoclonal gammopathies may fail to benefit patients while increasing healthcare costs, according to research published in The American Journal of Clinical Pathology.
Researchers conducted a review of all tests for investigating monoclonal gammopathies at a single institution and found that fewer than half of the serum immunofixation and serum free light chain assays performed were actually warranted.
According to the researchers, these results suggest that, instead of ordering individual tests, physicians should request an initial workup for monoclonal gammopathy.
Once pathologists interpret results of a screening serum protein electrophoresis (SPEP) and examine the patient’s medical record, they can decide what, if any, additional tests are needed.
“These are stepwise things,” said study author Gurmukh Singh, MD, PhD, of the Medical College of Georgia at Augusta University.
“If it’s a new patient, do this. If it’s a known patient, do that. Results drive it. That will reduce the number of tests that are done without in any way being of detriment to the patient or the quality of care.”
To conduct this study, Dr Singh and his colleagues reviewed the history of 237 patients, ages 19 to 87, who had a total of 1503 episodes of testing.
In addition to SPEP, many patients had serum immunofixation electrophoresis and/or serum free light chain assays.
But the researchers found that only 46% of the serum immunofixation and 42% of the serum free light chain assays were warranted.
The 2 tests were ordered multiple times in patients in whom M-protein was easily detected with SPEP. In fact, for most patients with measurable levels of M-protein, SPEP can be used to follow the course of the disease and treatment, the researchers said.
“About 40% to 50% of the second tests are not needed or adding value,” Dr Sing stressed.
In fact, he and his colleagues estimated that putting an end to unnecessary testing would have saved $64,182.95 per year in healthcare costs at this institution.
Therefore, the researchers propose using an algorithm that would put more of the decision-making in the hands of pathologists interpreting the tests.
An example of when serum immunofixation and serum free light chain assays should be done at least once is in a new patient when M-protein is first found, Dr Singh said. The additional tests might also be beneficial for patients under treatment for multiple myeloma, to ensure there are no trace amounts left of the abnormal protein.
Dr Singh added that testing patterns similar to those observed in this study are in play in hospitals across the US. However, a protocol similar to the one he is proposing has safely enabled up to a 60% reduction in the volume of second tests at a Missouri hospital where it has been in use for about 8 years.
“It’s better for patients and for healthcare delivery in general,” Dr Singh said. “Why spend money that you don’t need to spend when you are not gaining information that will benefit the patient’s outcome?”
