Valutazione dell'efficacia di raccomandazioni aziendali sulle strategie per l'impiego ottimale dei biomarcatori in oncologia ad un anno dalla loro introduzione

Alberto Dolci, Luisa Scapellato, Mauro Panteghini
U.O. Laboratorio Analisi Chimico Cliniche, Ospedale 'Luigi Sacco' e Cattedra di Biochimica Clinica e Biologia Molecolare Clinica, Dipartimento di Scienze Cliniche, Università degli Studi, Milano

Biochimica Clinica: 2008; 32(3): 181-185 [Article in italian]

ABSTRACT
One-year audit of the implementation of recommendations for optimal use of tumor biomarkers in a university hospital. Tumor biomarkers are increasingly used to make clinical decisions in oncology. It is therefore mandatory to provide evidence-based information both about the optimal use as well as the limitations of these tests to improve appropriateness of their measurement. For this reason we prepared local recommendations for correct tumor biomarker use. According to the oncologists and in agreement with the available international guidelines, we identified the recommended biomarker(s) for any specific clinical goal of different malignancies. As a general rule, we established a maximum of two biomarker requests in the same order except for well documented clinical situations. To evaluate the impact of recommendations, we compared the same one-year period before and after guideline implementation. The total number of tumor biomarker requests decreased from 14,681 to 6,577 (-55.2%), with some differences among clinical departments and available biomarkers. Alpha-fetoprotein showed the highest decrease (-67.9%), followed by neuron-specific enolase (-65.5%) and CA125 (-65%). In terms of reagent costs, the laboratory saved € 38,229 per year. During the evaluated period, 349 orders asking for more than two biomarkers were discussed with the clinicians and all but three were brought back to the recommendations. In conclusion, implementing recommendations on correct use of tumor biomarkers in a teaching hospital largely decrease the number of ordered tests and reagent costs, without any impact on their clinical role.

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