Inappropriate Tumour Marker Requesting

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Inappropriate Tumour Marker Requesting More
Costly Than You Think!
Gemma Dodds Clinical Biochemistry Hope
Hospital Salford M6 8HD
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Basis for the audit

• Many inappropriate or no clinical details
  supplied
• Looked at 5 main tumour markers
• AFP, PSA, CA 125, CA 19-9 and CEA
• Aims
• What proportion of requests are deemed
  inappropriate based on their clinical details and
  current guidelines
• Assist demand management of the tests

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• Appropriateness of clinical details supplied
  based on
• NACB Practice guidelines and recommendations
  for use of tumour markers in the clinic
• ACBI Guidelines for the use of tumour markers
  (April 2005)
• Appropriate - stated in current guidelines as a
  recognised indication for measuring this tumour
  marker.
• Related but inappropriate - related to those
  recognised as appropriate but are not recognised
  indications themselves.
• Inappropriate - do not appear in current
  guidelines as a recognised reason for measuring
  this tumour marker.
• None given.

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Overall appropriateness of requests
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AFP
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CA 125
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PSA
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CEA
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CA 19-9
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Financial data 1

• No of tests per year cost per test
• no of inappropriate
• Used to est. cost per year of inappropriate
  tests for each marker
• Statistical analysis used to establish 95
  confidence intervals for these costs

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Financial data 2
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Action taken

• New tumour marker specific comments to replace
  general comment
• Except for PSA which already has specific comment
• Letter to main outside hospital Birch Hill
• Plan to re-audit in the future

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Acknowledgements

• Felicity Stewart
• Aram Rudenski
• John Kane