Defense Date

2013

Document Type

Dissertation

Degree Name

Doctor of Philosophy

Department

Health Related Sciences

First Advisor

William J. Korzun

Abstract

Clinical laboratory test results are integral to patient management. Important aspects of laboratory tests’ contributions are the use of the test information and the role they have in facilitating efficient and effective use of healthcare resources. Methods of measuring those contributions were examined using quantitative HCV RNA test results (HCV VL) in therapeutic management decisions as a model. Test precision is important in those decisions; therefore, the clinical use was evaluated by studying the impact that knowledge of inherent assay imprecision had on clinicians’ decisions. A survey describing a simulated patient at a decision point for HCV triple-combination therapy management was sent to 1491 hepatology clinicians. Participants saw HCV RNA results at five different levels and were asked to choose to: continue therapy, discontinue therapy, or repeat the test. Test results were presented both with and without the 95% confidence intervals (CIs). Three of the VLs had CIs that overlapped the therapeutic decision level. Participants saw both sets of results in random order. Demographics and practice preferences were also surveyed. One-hundred-thirty-eight responses were received. Adherence to clinical guidelines was demonstrated in self-reported behaviors and in most decisions. However, participants chose to repeat the test up to 37% of the time. The impact of the knowledge of assay imprecision did not have a statistically significant effect on clinicians’ decisions. To determine economic value, an analytic decision-tree model was developed. Transition probabilities, costs, and Quality of Life values were derived from published literature. Survey respondents’ decisions were used as model inputs. Across all HCV VL levels, the calculated test value was approximately $2600, with up to $17,000 in treatment-related cost savings per patient at higher HCV VLs. The test value prevailed regardless of the presence or absence of CIs, and despite repeat testing. The calculated value in cost savings/patient was up to 100 times the investment for HCV VL testing. Laboratory tests are investments in efficient uses of healthcare resources. Proper interpretation and use of their information is integral to that value. This type of analysis can inform institutional decisions and higher level policy discussions.

Rights

© The Author

Is Part Of

VCU University Archives

Is Part Of

VCU Theses and Dissertations

Date of Submission

12-13-2013

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