Objectives:

This study assessed the level of appropriateness of tumor marker requests in a teaching hospital and estimated the financial cost associated with inappropriate use.

Methods:

A retrospective review of patients’ electronic records was conducted over a 3-year period (2015–2017) for tumor marker requests, including carcinoembryonic antigen, alpha-fetoprotein, cancer antigen (CA)15-3, CA125, CA19-9, and total and free prostate-specific antigen (PSA and fPSA), along with the associated clinical data that motivated the requests. Inappropriate use was defined as tumor marker requests without any relevant clinical picture. Costs due to inappropriate tumor marker requests were estimated based on the unit costs applied in the institution.

Results:

A total of 7128 patients had at least one tumor marker request between 2015 and 2017. The clinical picture that motivated tumor marker requests was absent in 71.5%, while 12.9% of the requests were associated with a malignancy. The most frequent prescribing pattern was total prostate-specific antigen alone (2128; 29.9%), followed by alpha-fetoprotein alone (1185; 16.6%), and carcinoembryonic antigen alone (506; 7.1%). Year-over-year analysis revealed an increasing tendency in requesting carcinoembryonic antigen and CA15-3. The rate of inappropriate use varied by tumor marker and ranged between 56.4% for fPSA and 86.8% for total prostate-specific antigen. The overall costs due to inappropriate tumor marker requests were estimated at $2,785,493 over the 3 years, representing an average of $0.93 million per year.

Conclusion:

Inappropriate use of tumor marker requests is a major issue regarding its high prevalence and the considerable associated costs. The role of laboratories in the management of tumor marker requests should be emphasized.

中文翻译：

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沙特阿拉伯西部一所大学医院对肿瘤标志物要求的不当做法：一项为期 3 年的回顾性研究

目标：

本研究评估了教学医院中肿瘤标志物要求的适当程度，并估计了与不当使用相关的财务成本。

方法：

在 3 年期间（2015-2017 年）对患者的电子记录进行了回顾性审查，以获取肿瘤标志物请求，包括癌胚抗原、甲胎蛋白、癌抗原 (CA)15-3、CA125、CA19-9 和总和游离前列腺特异性抗原（PSA 和 fPSA），以及激发请求的相关临床数据。不当使用被定义为没有任何相关临床图片的肿瘤标志物要求。由于不适当的肿瘤标志物请求导致的成本是根据机构中应用的单位成本估算的。

结果：

在 2015 年至 2017 年期间，共有 7128 名患者至少提出了一项肿瘤标志物请求。71.5% 的患者没有提出肿瘤标志物请求的临床表现，而 12.9% 的请求与恶性肿瘤相关。最常见的处方模式是单独的总前列腺特异性抗原（2128；29.9%），其次是单独的甲胎蛋白（1185；16.6%）和单独的癌胚抗原（506；7.1%）。逐年分析显示，对癌胚抗原和 CA15-3 的需求呈增加趋势。不恰当使用率因肿瘤标志物而异，fPSA 为 56.4%，总前列腺特异性抗原为 86.8%。由于不适当的肿瘤标志物请求导致的总成本在 3 年内估计为 2,785,493 美元，平均每年 93 万美元。

结论：

不恰当地使用肿瘤标志物要求是其高流行率和相当大的相关成本的主要问题。应强调实验室在管理肿瘤标志物请求中的作用。