Financial Burden of Unnecessary Test Request for Thyroid Tests in Public Health Laboratory: To What Extent the Algorithms are Used?

INTRODUCTION: In this study, we aimed to investigate the financial burden of not performing thyroid function tests (TFT) according to the algorithms in diagnosis and treatment guidelines.
METHODS: The TFT results of 61.422 patients whose testing was requested between 01.01.2018-31.12.2018 in Amasya Public Health Laboratory were analyzed retrospectively. The results of the patients were grouped according to the diagnoses specified in the diagnosis and treatment guidelines (euthyroid, hyperthyroid and hypothyroid). In addition, patients were grouped according to the type of test request (group 1: Thyroid stimulating hormone (TSH), group 2: TSH and free triiodotyronine (fT3), group 3: TSH and free throxine (fT4), group 4: TSH, fT4 and fT3).
RESULTS: Among these patient results, the number of patients who received TSH only in the first step, in line with the algorithms, was 12.522 (20.2%). The number of the patients from whom TSH and fT3 were requested together was identified as 703 (1.1%), fT4 and TSH together as 6343 patients (11.2%) and all three tests (TSH, fT4 and fT3) as 41.854 (67.5%). The total cost of the test requests was calculated as 388.426 Turkish Liras per annum, which was repaid to institutions in accordance with the principles of Health Practice Communiqué.
DISCUSSION AND CONCLUSION: According to the results we obtained, it was found that the algorithms related to the request of thyroid tests were not followed, and the financial implications of this situation were high. We believe that the inclusion of applications, such as reflex testing in laboratory automation and planning of training for algorithms, will reduce improper test requests and unnecessary financial burden.