K. von Bremen

¹Medtronic Europe Sàrl, Route du Mollian 31, CH-1131 Tolochenaz

Laboratory medicine was at the forefront of economic assessment well before clinical medicine. Costs of tests and procedures were known when evidence based medicine was discovered. Where are we now?

Methods of health economic assessment have been validated since the 80s leaving laboratory medicine aside. In the current times of severe cost containment and budget restrictions different areas of health care have to overcome the hurdle of isolation and participate actively in an integrated treatment process.
Cost effectiveness analysis is one of the cornerstones in health economic assessment relating costs and clinical outcome. Cost effectiveness ratio should tell us what procedure to favour, but does not tell whether we can afford it. Changing viewpoint also changes cost effectiveness, meaning that positions and endpoints have to be clearly set.
Cost utility analysis enters patient’s quality of life as a quantitative parameter into the evaluation process, adding an essential but still subjective aspect. Cost benefit analysis is the last to be fully validated in health care as it translates care into costs and compares costs with costs.
Cost containment processes always liked to look very closely at laboratory medicine because production of results and assessment of the costs is much easier to obtain than quantitative data for assessing costs and results of the direct care of patients as often co-morbidity renders cost assignment and clear endpoints difficult to define.
The narrow view focussing on the laboratory for rationalisation and cost containment; tends to ignore that laboratory medicine not only produces results but offers an essential 24h service in the medical decision making process.
Laboratory tests have very different roles in the treatment process. They contribute to the exclusion, suspicion or confirmation of a disorder or the follow up of a known disease, not to forget screening for disabling diseases and tests for prognosis and prevention. Their benefit is the 24 hour support for medical decision making.
It is time to stress the real value of laboratory medicine as part of the whole evaluation of community cost effectiveness in health care. Omitting the full integration of laboratory medicine in the economic assessment of the whole patient care path by looking at laboratory medicine in an isolated way, could well result in reduced quality of health care and avoidable costs as a consequence of rationing at the wrong place.