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Ignatiadis M, Poulakaki F, Spanic T, Brain E, Lacombe D, Sonke GS, Vincent-Salomon A, Van Duijnhoven F, Meattini I, Kaidar-Person O, Aftimos P, Lecouvet F, Cardoso F, Retèl VP, Cameron D. EBCC-14 manifesto: Addressing disparities in access to innovation for patients with metastatic breast cancer across Europe. Eur J Cancer 2024; 207:114156. [PMID: 38861756 DOI: 10.1016/j.ejca.2024.114156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 05/29/2024] [Accepted: 05/30/2024] [Indexed: 06/13/2024]
Abstract
The European Breast Cancer Council (EBCC) traditionally identifies controversies or major deficiencies in the management of patients with breast cancer and selects a multidisciplinary expert team to collaborate in setting crucial principles and recommendations to improve breast cancer care. The 2024 EBCC manifesto focuses on disparities in the care of patients with metastatic breast cancer. There are several reasons for existing disparities both between and within countries. Our recommendations aim to address the stigma of metastatic disease, which has led to significant disparities in access to innovative care regardless of the gross national income of a country. These recommendations are for different stakeholders to promote the care of patients with metastatic breast cancer across Europe and worldwide.
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Affiliation(s)
- Michail Ignatiadis
- Department of Medical Oncology, Institut Bordet, Hôpital Universitaire de Bruxelles, Brussels, Belgium.
| | - Fiorita Poulakaki
- Breast Surgery Department, Athens Medical Center, Athens, Greece; Europa Donna - The European Breast Cancer Coalition, Milan, Italy
| | - Tanja Spanic
- Europa Donna - The European Breast Cancer Coalition, Milan, Italy; Europa Donna Slovenia, Ljubljana, Slovenia
| | - Etienne Brain
- Department of Medical Oncology, Institut Curie, Saint Cloud, France
| | - Denis Lacombe
- European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - Gabe S Sonke
- University of Amsterdam, Amsterdam, the Netherlands
| | - Anne Vincent-Salomon
- Department of Diagnostic and Theragnostic Medicine, Institut Curie Hospital Group, Paris, France
| | - Frederieke Van Duijnhoven
- Department of Surgical Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Icro Meattini
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", University of Florence, Florence, Italy; Radiation Oncology & Breast Unit, Oncology Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Orit Kaidar-Person
- Department of Radiation Oncology, Sheba Medical Center, Ramat Gan, Israel; Tel Aviv School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Philippe Aftimos
- Department of Medical Oncology, Institut Bordet, Hôpital Universitaire de Bruxelles, Brussels, Belgium
| | - Frederic Lecouvet
- Institut du Cancer Roi Albert II (IRA2), Institut de Recherche Expérimentale et Clinique, UCLouvain, Brussels, Belgium; Department of Medical Imaging, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - Fatima Cardoso
- Breast Unit, Champalimaud Clinical Center/Champalimaud Foundation, Lisbon, Portugal
| | - Valesca P Retèl
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands; Erasmus School of Health Policy and Management, Erasmus University Rotterdam (ESHPM), Rotterdam, the Netherlands
| | - David Cameron
- Edinburgh University Cancer Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
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Awwad S, Al-Hamdani M, Abdallah AM, Abu-Madi M. Laboratory testing efficiency during the COVID pandemic: Findings from the Primary Health Care Corporation laboratories in the State of Qatar. J Infect Public Health 2024; 17:681-686. [PMID: 38471258 DOI: 10.1016/j.jiph.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/28/2024] [Accepted: 03/03/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Little is known about how the COVID-19 pandemic altered laboratory testing efficiency in the State of Qatar. The aim of this study was to assess laboratory testing efficiency with respect to the total number and proportion of C-reactive protein (CRP), complete blood count (CBC), and comprehensive metabolic panel (CMP) tests completed on time in 2019-2021 in several ordinary and COVID-converted Primary Health Care Corporation (PHCC) health centers across Qatar. METHODS Secondary data from 2019 to 2021 were accessed from the PHCC-Clinical Information System center. Six randomly selected centers from three regions of Qatar (Northern, Central, and Western), two of which were COVID-converted, were analyzed. RESULTS A total of 404,316 laboratory tests were analyzed. There were decreasing, U-shaped, and inverted-U-shaped patterns in the numbers of tests conducted in different regions between 2019 and 2021 according to test type. The proportion of urgent (STAT) CBC and CMP tests increased from 2019 to 2021, and the proportion of tests completed by COVID-converted health centers increased for CRP and CBC and decreased for CMP between 2019 and 2021. Northern and Western regions in Qatar showed higher efficiency than the Central region with respect to the proportion of STAT tests completed on time in 2019-2021. COVID-converted centers completed fewer STAT CBC tests on time than ordinary centers. CONCLUSION Pandemics such as COVID-19 shift the allocation of resources from routine tests to urgent tests, as exemplified by the increase in STAT test proportions in 2019 to 2021. High population densities, as noted in the Central region of Qatar, may require additional resources during pandemics to complete urgent tests more efficiently. The conversion of centers to COVID-converted centers may not necessarily translate into higher urgent test efficiency, as exemplified by the STAT CBC test results.
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Affiliation(s)
- Sara Awwad
- Department of Biomedical Sciences, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Mohammed Al-Hamdani
- Department of Public Health, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Atiyeh M Abdallah
- Department of Biomedical Sciences, College of Health Sciences, QU Health, Qatar University, Doha, Qatar
| | - Marawan Abu-Madi
- Department of Biomedical Sciences, College of Health Sciences, QU Health, Qatar University, Doha, Qatar.
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Shang X, Zhao F, Du J, Li R, Xia L, Hou L, Cheng X, Ding Y, Li P, Liu M, Ma C, Wang Z, Ding J, Ge Z, Wang G, Guo T, Fu Y, Xiao M, Yang Q, Qiu L, Xu Y. Development and clinical evaluation of an online automated quality control system for improving laboratory quality management. Clin Chim Acta 2023; 541:117240. [PMID: 36736683 DOI: 10.1016/j.cca.2023.117240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/26/2023] [Accepted: 01/27/2023] [Indexed: 02/03/2023]
Abstract
BACKGROUND We developed an efficient online automated quality control (AUTO QC) system and tested its feasibility on automatic laboratory assembly lines. METHODS AUTO QC is based on developed quality control software (Smart QC) and designed adaptable consumables before. We applied the system to two assembly lines in our laboratory. Using third-party quality control samples, we evaluated the impact of the online AUTO QC system on out-of-control rate, biosecurity risk, turnaround time (TAT) and cost. RESULTS AUTO QC significantly decreased the occurrence rate of the Westgard quality control rules 13S/22S/R4s and 12S, representing out-of-control and warning, respectively. The out-of-control rates were reduced by 58%, and the potential biosecurity risk of the samples decreased by 90%. The AUTO QC implementation also reduced the median TAT (by 7 min), the number of full-time employees and the cost of the quality control samples (by 45%). CONCLUSIONS The total laboratory AUTO QC system can improve the quality and stability of QC testing and reduce cost.
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Affiliation(s)
- Xuesong Shang
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China; Department of State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Fang Zhao
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China; Department of State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Juan Du
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China; Department of State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Rui Li
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China; Department of State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Liangyu Xia
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China; Department of State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Lian Hou
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China; Department of State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xinqi Cheng
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China; Department of State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yingying Ding
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China; Department of State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Peng Li
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China; Department of State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Meizhi Liu
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China; Department of State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Chaochao Ma
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China; Department of State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Zhe Wang
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China; Department of State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Jinwen Ding
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China; Department of State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Zengmei Ge
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China; Department of State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Guanhua Wang
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China; Department of State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Tai Guo
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China; Department of State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yu Fu
- Sightnovo Medical Technology Co., Ltd, Beijing, China
| | - Meng Xiao
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China; Department of State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
| | - Qiwen Yang
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China; Department of State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
| | - Ling Qiu
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China; Department of State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
| | - Yingchun Xu
- Department of Laboratory Medicine, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Science, Beijing, China; Department of State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
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Mukhopadhyay T, Shekhar S, Sen A. Post-graduate training in Laboratory Medicine: Potential to fill a crucial gap in Indian healthcare system. Med J Armed Forces India 2022; 78:249-254. [DOI: 10.1016/j.mjafi.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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5
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Aslan H, Top M. Costs of unnecessary repeated diagnostic tests in cholecystectomy. Int J Health Plann Manage 2022; 37:1799-1815. [DOI: 10.1002/hpm.3442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 11/19/2021] [Accepted: 02/08/2022] [Indexed: 11/07/2022] Open
Affiliation(s)
- Hüseyin Aslan
- Department of Health Care Management Sakarya University of Applied Sciences Sakarya Turkey
| | - Mehmet Top
- Department of Health Care Management Hacettepe University Ankara Turkey
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Lai C, Yee SY, Ying T, Chadban S. Biomarkers as diagnostic tests for delayed graft function in kidney transplantation. Transpl Int 2021; 34:2431-2441. [PMID: 34626503 DOI: 10.1111/tri.14132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 08/29/2021] [Accepted: 10/04/2021] [Indexed: 11/26/2022]
Abstract
Delayed graft function (DGF) after kidney transplantation is associated with inferior outcomes and higher healthcare costs. DGF is currently defined as the requirement for dialysis within seven days post-transplant; however, this definition is subjective and nonspecific. Novel biomarkers have potential to improve objectivity and enable earlier diagnosis of DGF. We reviewed the literature to describe the range of novel biomarkers previously studied to predict DGF. We identified marked heterogeneity and low reporting quality of published studies. Among the novel biomarkers, serum NGAL had the greatest potential as a biomarker to predict DGF, but requires further assessment and validation through larger scale studies of diagnostic test performance. Given inadequacies in the dialysis-based definition, coupled with the high incidence and impact of DGF, such studies should be pursued.
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Affiliation(s)
- Christina Lai
- Renal Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Kidney Node, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Seow Yeing Yee
- Nephrology Department, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Tracey Ying
- Renal Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Kidney Node, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Steve Chadban
- Renal Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Kidney Node, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
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Beriault DR, Gilmour JA, Hicks LK. Overutilization in laboratory medicine: tackling the problem with quality improvement science. Crit Rev Clin Lab Sci 2021; 58:430-446. [PMID: 33691585 DOI: 10.1080/10408363.2021.1893642] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Overutilization of tests and treatments is a widespread problem in contemporary heath care, and laboratory medicine is no exception. It is estimated that 10-70% of laboratory tests may be unnecessary, with estimates in the literature varying depending on the situation and the laboratory test. Inappropriate use of laboratory tests can lead to further unnecessary testing, adverse events, inaccurate diagnoses, and inappropriate treatments. Altogether, this increases the risk of harm to a patient, which can be physical, psychological, or financial in nature. Overutilization in healthcare is driven by complex factors including care delivery models, litigious practice environments, and medical and patient culture. Quality improvement (QI) methods can help to tackle overutilization. In this review, we outline the global healthcare problem of laboratory overutilization, particularly in the developed world, and describe how an understanding of and application of quality improvement principles can help to address this challenge.
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Affiliation(s)
- Daniel R Beriault
- Department of Laboratory Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Julie A Gilmour
- Division of Endocrinology, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Lisa K Hicks
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Hematology and Oncology, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
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8
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Horgan D, Ciliberto G, Conte P, Curigliano G, Seijo L, Montuenga LM, Garassino M, Penault-Llorca F, Galli F, Ray-Coquard I, Querleu D, Riegman P, Kerr K, Van Poppel H, Bjartell A, Codacci-Pisanelli G, Koeva-Balabanova J, Paradiso A, Maravic Z, Fotaki V, Malats N, Bernini C, Buglioni S, Kent A, Munzone E, Belina I, Van Meerbeeck J, Duffy M, Jagielska B, Capoluongo E. Bringing Onco-Innovation to Europe's Healthcare Systems: The Potential of Biomarker Testing, Real World Evidence, Tumour Agnostic Therapies to Empower Personalised Medicine. Cancers (Basel) 2021; 13:cancers13030583. [PMID: 33540773 PMCID: PMC7867284 DOI: 10.3390/cancers13030583] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 11/18/2020] [Accepted: 01/15/2021] [Indexed: 12/12/2022] Open
Abstract
Simple Summary The increasing number of data supporting use of a personalized approach in cancer treatment, is changing the path of patient’s management. In the same time, the availability of technologies should allow patients to receive the best test for the specific individual condition. This is theoretically true, when a specific test is designed for the specific disease condition, while it is difficult to implement in the setting of agnostic therapies. Financial sources availability related to the non homogeneous health systems working in the different countries do not allow for an immediate implementation of the technologies and test commercially available. Future perspectives for targeted oncology include tumor-agnostic drugs, which target a given mutation and could be used in treating cancers from multiple organ types. Therefore, the present paper is aimed to both underline a how much important is this new view and also to sensitize the international bodies that supervise health policies at the decision-making level, with the aim of harmonizing cancer treatment pathways in at least all European countries. Abstract Rapid and continuing advances in biomarker testing are not being matched by uptake in health systems, and this is hampering both patient care and innovation. It also risks costing health systems the opportunity to make their services more efficient and, over time, more economical. The potential that genomics has brought to biomarker testing in diagnosis, prediction and research is being realised, pre-eminently in many cancers, but also in an ever-wider range of conditions—notably BRCA1/2 testing in ovarian, breast, pancreatic and prostate cancers. Nevertheless, the implementation of genetic testing in clinical routine setting is still challenging. Development is impeded by country-related heterogeneity, data deficiencies, and lack of policy alignment on standards, approval—and the role of real-world evidence in the process—and reimbursement. The acute nature of the problem is compellingly illustrated by the particular challenges facing the development and use of tumour agnostic therapies, where the gaps in preparedness for taking advantage of this innovative approach to cancer therapy are sharply exposed. Europe should already have in place a guarantee of universal access to a minimum suite of biomarker tests and should be planning for an optimum testing scenario with a wider range of biomarker tests integrated into a more sophisticated health system articulated around personalised medicine. Improving healthcare and winning advantages for Europe’s industrial competitiveness and innovation require an appropriate policy framework—starting with an update to outdated recommendations. We show herein the main issues and proposals that emerged during the previous advisory boards organised by the European Alliance for Personalized Medicine which mainly focus on possible scenarios of harmonisation of both oncogenetic testing and management of cancer patients.
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Affiliation(s)
- Denis Horgan
- European Alliance for Personalized Medicine, Avenue de l’Armee/ Legerlaan 10, 1040 Brussels, Belgium;
- Correspondence: (D.H.); (E.C.)
| | - Gennaro Ciliberto
- IRCCS Istituto Nazionale Tumori “Regina Elena”, Via Elio Chianesi, 53, 00128 Rome, Italy; (G.C.); (S.B.)
| | - Pierfranco Conte
- Dipartimento di Scienze Chirurgiche Oncologiche e Gastroenterologiche, University of Padova, Via Giustiniani 2, 35128 Padova, Italy;
| | - Giuseppe Curigliano
- Department of Oncology and Hemato-Oncology, University of Milano and European Institute of Oncology, IRCCS, 20139 Milano, Italy;
| | - Luis Seijo
- Pulmonary Department, Clínica Universidad de Navarra, Calle Marquesado de Sta. Marta, 1, 28027 Madrid, Spain;
- Ciber Enfermedades Respiratorias (CIBERES), Av. de Monforte de Lemos, 3-5, 28029 Madrid, Spain
| | - Luis M. Montuenga
- Center for Applied Medical Research (CIMA), Schools of Sciences and Medicine, University of Navarra, Av. de Pío XII, 55, 31008 Pamplona, Spain;
- CIBERONC, Av. Monforte de Lemos, 3-5, 28029 Madrid, Spain;
| | - Marina Garassino
- S.S. Oncologia Medica Toraco Polmonare, Fondazione IRCCS Istituto Nazionale dei Tumori Via Giacomo Venezian, 1, 20133 Milano, Italy;
| | - Frederique Penault-Llorca
- Department of Pathology and Tumor Biology, University of Clermont-Auvergne, 49 bd François Mitterrand, 63001 Clermont-Ferrand, France;
| | - Fabrizia Galli
- Associazione aBRCAdaBRA Onlus Via Volontari Italiani del Sangue, 32, 90128 Palermo, Italy;
| | - Isabelle Ray-Coquard
- Medical Oncology Department, Centre Leon Bérard & Université Claude Bernard Lyon, 69008 Lyon, France;
| | - Denis Querleu
- Surgery Department, Institut Bergonié Cancer Center, Centre Léon Bérard Cheney D- 2 ème étage -28 Rue Laennec, 69373 Lyon, France;
| | - Peter Riegman
- Department of Pathology, Josephine Nefkens Institute, Erasmus Medical Center, Be 235b, Dr Molwaterplein 50, 3015 Rotterdam, The Netherlands;
| | - Keith Kerr
- Department of Pathology, University of Aberdeen, King’s College, Aberdeen AB24 3FX, UK;
| | - Hein Van Poppel
- Department of Urology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium;
| | - Anders Bjartell
- Department of Urology, Skane University Hospital, Box 117, 221 00 Lund, Sweden;
| | - Giovanni Codacci-Pisanelli
- Department of Medical and Surgical Sciences and Biotechnology, University of Rome, “la Sapienza”, Piazzale Aldo Moro, 5, 00185 Roma, Italy;
| | | | - Angelo Paradiso
- Scientific Directorate, IRCCS Istituto Tumori Giovanni Paolo II, Viale Orazio Flacco, 65, 70124 Bari, Italy;
| | - Zorana Maravic
- Digestive Cancers Europe, Rue de la Loi 235, 1040 Brussels, Belgium; (Z.M.); (V.F.)
| | - Vassiliki Fotaki
- Digestive Cancers Europe, Rue de la Loi 235, 1040 Brussels, Belgium; (Z.M.); (V.F.)
| | - Nuria Malats
- CIBERONC, Av. Monforte de Lemos, 3-5, 28029 Madrid, Spain;
- Spanish National Cancer Research Centre (CNIO), Calle de Melchor Fernández Almagro, 3, 28029 Madrid, Spain
| | - Chiara Bernini
- European Alliance for Personalized Medicine, Avenue de l’Armee/ Legerlaan 10, 1040 Brussels, Belgium;
| | - Simonetta Buglioni
- IRCCS Istituto Nazionale Tumori “Regina Elena”, Via Elio Chianesi, 53, 00128 Rome, Italy; (G.C.); (S.B.)
| | - Alastair Kent
- Independent Patient Advocate, 14 Farthing Road Downham Market, Norfolk PE38 0AF, UK;
| | - Elisabetta Munzone
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141 Milano, Italy;
| | - Ivica Belina
- KUZ-Coalition of Association in Healthcare, Trpimirova 11, 10000 Zagreb, Croatia;
| | - Jan Van Meerbeeck
- Thoracic Oncology-MOCA, University Hospital Antwerp, Wilrijkstraat 10, 2650 Edegem, Belgium;
| | - Michael Duffy
- UCD School of Medicine, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Belfield, Dublin 4, Ireland;
| | - Beata Jagielska
- Maria Skłodowska-Curie Institute of Oncology, Wawelska 15 B, 00-001 Warszawa, Poland;
| | - Ettore Capoluongo
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, 80131 Naples, Italy
- CEINGE-Biotecnologie Avanzate, Via Gaetano Salvatore, 486, 80131 Napoli, Italy
- Correspondence: (D.H.); (E.C.)
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Bahati F, English M, Sayed S, Horton S, Odhiambo OA, Samatar AA, McKnight J. Information asymmetry in the Kenyan medical laboratory sector. Glob Health Action 2021; 14:1964172. [PMID: 34445946 PMCID: PMC8405108 DOI: 10.1080/16549716.2021.1964172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 07/30/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Important information about medical laboratory providers is not readily available to all patients, clinicians nor regulators in Kenya. This study was conducted as part of a wider project aiming to improve access to high quality diagnostics by addressing information asymmetries in the Kenyan market for laboratory services. OBJECTIVES The purpose of this study was to: 1) Gather pricing information for 49 common laboratory tests from medical laboratories in Nairobi, Kenya, noting where these prices were publicly available or withheld. 2) Assess patients' knowledge of testing information including: turnaround time, price, and test availability. METHOD This was a cross-sectional study where a mystery caller approach was used to survey 49 tests for turnaround time, price, and availability across 13 laboratories selected purposively. The mystery shopper survey was complemented by 251 patient exit interviews at two Kenyan hospitals to understand whether patients seeking laboratory tests in Nairobi had access to such information. All 251 patients were selected by convenience sampling. RESULTS We noted that 85% of the private laboratories did not disclose test prices and turnaround times to their patients. There was a wide range of prices on several key tests, with private in-facility laboratories charging an average test price of 468% of the average test price in public laboratories across all the 49 tests. We also found that many patients lacked key information regarding the tests they needed: 65% did not know the purpose of the test while 41% did not know the test price at all. CONCLUSION Under the current system, patients have limited access to information regarding the key criteria required to make a rational decision. This has a significant impact on the quality, price, and turnaround time (TAT) offered by the medical laboratories that operate in this dysfunctional market.
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Affiliation(s)
- Felix Bahati
- Health Services Research Unit, KEMRI Wellcome Trust Research Programme, Nairobi, Kenya
| | - Mike English
- Health Services Research Unit, KEMRI Wellcome Trust Research Programme, Nairobi, Kenya
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Shahin Sayed
- Department of Pathology, Aga Khan University Hospital, Nairobi, Kenya
| | - Susan Horton
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - Onyango Abel Odhiambo
- Department of Regulatory Affairs, Kenya Medical Laboratory Technicians & Technologists Board, Nairobi, Kenya
| | - Abdulatif A Samatar
- Department of Regulatory Affairs, Kenya Medical Laboratory Technicians & Technologists Board, Nairobi, Kenya
| | - Jacob McKnight
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
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10
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Casas ML, Esteban Á, González-Muñoz M, Labrador-Horrillo M, Pascal M, Teniente-Serra A. Proyecto VALIDA: Validation of ALlergy In vitro Diagnostics Assays (Herramientas y recomendaciones para la valoración de las pruebas in vitro en el diagnóstico de la alergia). ADVANCES IN LABORATORY MEDICINE 2020; 1:20200022. [PMCID: PMC10197503 DOI: 10.1515/almed-2020-0022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 05/05/2020] [Indexed: 08/29/2023]
Abstract
En la evaluación del paciente con sospecha de alergia las pruebas de detección y cuantificación de la inmunoglobulina E (IgE) específica in vitro se usan de manera habitual en los laboratorios clínicos para ayudar en el diagnóstico de la alergia. Actualmente existen diferentes alternativas comerciales para realizar estos ensayos, pero los resultados obtenidos por cada uno de ellos pueden variar, lo que condiciona el diagnóstico y el tratamiento que se le proporcionará al paciente. Con el fin de dar respuesta a los retos planteados por las diferencias entre las distintas técnicas para la determinación in vitro de la IgE específica, un grupo de expertos ha recogido en un documento una serie de recomendaciones sobre las implicaciones que puede tener el uso de una determinada técnica in vitro y el impacto en el manejo del paciente alérgico que suponen las diferencias entre las distintas técnicas. La lectura y el análisis de este documento de consenso ayudarán a entender las implicaciones que tiene el cambio de método de diagnóstico in vitro en el manejo del paciente con alergia, en su calidad de vida y en los costes socioeconómicos asociados a la enfermedad.
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Affiliation(s)
- María L. Casas
- Sociedad Española de Medicina de Laboratorio (SEQC-ML), Barcelona, España
- Servicio de Análisis Clínicos, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - Ángel Esteban
- Sociedad Española de Medicina de Laboratorio (SEQC-ML), Barcelona, España
- Servicio de Análisis Clínicos, Hospital General Universitario de Alicante, Alicante, España
| | - Miguel González-Muñoz
- Sociedad Española de Inmunología (SEI), Barcelona, España
- Servicio de Inmunología, Hospital Universitario La Paz, Madrid, España
| | - Moisés Labrador-Horrillo
- Sociedad Española de Alergología e Inmunología Clínica (SEAIC), Madrid, España
- Servicio de Alergología, Hospital Universitari Vall d’Hebron, Barcelona, España
| | - Mariona Pascal
- Servicio de Alergología, Hospital Universitari Vall d’Hebron, Barcelona, España
- Servicio de Inmunología, CDB, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, España
- Red de Investigación ARADyAL, Instituto Carlos III, Madrid, España
| | - Aina Teniente-Serra
- Sociedad Española de Inmunología (SEI), Barcelona, España
- Servicio de Inmunología, LCMN, Hospital Universitari Germans Trias i Pujol, Badalona, España
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11
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Casas ML, Esteban Á, González-Muñoz M, Labrador-Horrillo M, Pascal M, Teniente-Serra A. VALIDA project: Validation of allergy in vitro diagnostics assays (Tools and recommendations for the assessment of in vitro tests in the diagnosis of allergy). ADVANCES IN LABORATORY MEDICINE 2020; 1:20200051. [PMID: 37360620 PMCID: PMC10197418 DOI: 10.1515/almed-2020-0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 05/05/2020] [Indexed: 06/28/2023]
Abstract
In vitro allergen-specific immunoglobulin E (IgE) detection and quantification tests are routinely performed in clinical laboratories to diagnose patients with a suspected allergy. Numerous commercial assays are available to test for allergies, but the results can vary widely, thereby influencing both diagnosis and treatment. Given the challenges posed by differences in the various assays for in vitro determination of specific IgE, a group of experts has compiled in a document a series of recommendations on the implications that the use of a certain in vitro technique may have and the impact on the management of the allergic patient that the differences between the various techniques represent. The reading and analysis of this consensus document will help to understand the implications of the change of in vitro diagnostic method in the management of the patient with allergy, in the quality of life and in the socioeconomic costs associated with the disease.
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Affiliation(s)
- María L. Casas
- Clinical Analysis Service, Fundación Alcorcón University Hospital, Alcorcón, Madrid, Spain
- Spanish Society of Laboratory Medicine (SEQC-ML), Barcelona, Spain
| | - Ángel Esteban
- Spanish Society of Laboratory Medicine (SEQC-ML), Barcelona, Spain
- Clinical Analysis Service, University General Hospital of Alicante, Alicante, Spain
| | - Miguel González-Muñoz
- Immunology Service, La Paz University Hospital, Madrid, Spain
- Spanish Society of Immunology (SEI), Barcelona, Spain
| | - Moisés Labrador-Horrillo
- Allergology Service, Vall d’Hebron University Hospital, Barcelona, Spain
- Spanish Society of Allergology and Clinical Immunology (SEAIC), Madrid, Spain
| | - Mariona Pascal
- Spanish Society of Immunology (SEI), Barcelona, Spain
- Spanish Society of Allergology and Clinical Immunology (SEAIC), Madrid, Spain
- Immunology Service, CBD, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
- ARADyAL Research Network, Carlos III Institute, Madrid, Spain
| | - Aina Teniente-Serra
- Spanish Society of Immunology (SEI), Barcelona, Spain
- Immunology Service, LCMN, Germans Trias i Pujol University Hospital, Badalona, Spain
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12
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Horgan D, Ciliberto G, Conte P, Baldwin D, Seijo L, Montuenga LM, Paz-Ares L, Garassino M, Penault-Llorca F, Galli F, Ray-Coquard I, Querleu D, Capoluongo E, Banerjee S, Riegman P, Kerr K, Horbach B, Büttner R, Van Poppel H, Bjartell A, Codacci-Pisanelli G, Westphalen B, Calvo F, Koeva-Balabanova J, Hall S, Paradiso A, Kalra D, Cobbaert C, Varea Menendez R, Maravic Z, Fotaki V, Bennouna J, Cauchin E, Malats N, Gutiérrez-Ibarluzea I, Gannon B, Mastris K, Bernini C, Gallagher W, Buglioni S, Kent A, Munzone E, Belina I, Van Meerbeeck J, Duffy M, Sarnowska E, Jagielska B, Mee S, Curigliano G. Bringing Greater Accuracy to Europe's Healthcare Systems: The Unexploited Potential of Biomarker Testing in Oncology. Biomed Hub 2020; 5:182-223. [PMID: 33564664 DOI: 10.1159/000511209] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 08/31/2020] [Indexed: 12/11/2022] Open
Abstract
Rapid and continuing advances in biomarker testing are not being matched by take-up in health systems, and this is hampering both patient care and innovation. It also risks costing health systems the opportunity to make their services more efficient and, over time, more economical. This paper sets out the potential of biomarker testing, the unfolding precision and range of possible diagnosis and prediction, and the many obstacles to adoption. It offers case studies of biomarker testing in breast, ovarian, prostate, lung, thyroid and colon cancers, and derives specific lessons as to the potential and actual use of each of them. It also draws lessons about how to improve access and alignment, and to remedy the data deficiencies that impede development. And it suggests solutions to outstanding issues - notably including funding and the tangled web of obtaining reimbursement or equivalent coverage that Europe's fragmented health system implies. It urges a European evolution towards an initial minimum testing scenario, which would guarantee universal access to a suite of biomarker tests for the currently most common conditions, and, further into the future, to an optimum testing scenario in which a much wider range of biomarker tests would be introduced and become part of a more sophisticated health system articulated around personalised medicine. For exploiting genomics to the full, it argues the need for a new policy framework for Europe. Biomarker testing is not an issue that can be treated in isolation, since the purpose of testing is to improve health. Its use is therefore always closely linked to specific health challenges and needs to be viewed in the broader policy context in the EU and more widely. The paper is the result of extensive engagement with experts and decision makers to develop the framework, and consequently represents a wide consensus of views on how healthcare systems should respond from push and pull factors at local, national and cross-border and EU level. It contains strong views and clear recommendations springing from the convictions of patients, clinicians, academics, medicines authorities, HTA bodies, payers, the diagnostic, pharmaceutical and ICT industries, and national policy makers.
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Affiliation(s)
- Denis Horgan
- European Alliance for Personalised Medicine, Brussels, Belgium
| | | | | | - David Baldwin
- University of Nottingham, Nottingham, United Kingdom
| | - Luis Seijo
- Clinica Universidad de Navarra, CIBERES, Madrid, Spain
| | - Luis M Montuenga
- Center for Applied Medical Research (CIMA), University of Navarra and CIBERONC and IdisNa, Pamplona, Spain
| | - Luis Paz-Ares
- Hospital Doce de Octubre and CIBERONC, Madrid, Spain
| | | | | | | | | | | | | | - Susana Banerjee
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | | | - Keith Kerr
- Aberdeen University, Aberdeen, United Kingdom
| | | | | | | | | | | | - Benedikt Westphalen
- Grosshadern University Hospital, Ludwig-Maximilians University, Munich, Germany
| | | | | | | | | | - Dipak Kalra
- The European Institute for Innovation through Health Data (i∼HD), Gent, Belgium
| | - Christa Cobbaert
- European Federation of Clinical Chemistry and Laboratory Diagnostics, Milan, Italy
| | | | | | | | | | | | - Nuria Malats
- Spanish National Cancer Research Centre (CNIO) and CIBERONC, Madrid, Spain
| | - Iñaki Gutiérrez-Ibarluzea
- EuroScan International Network, Cologne, Germany.,BIOEF, Basque Foundation for Health Innovation and Research, Barakaldo, Spain
| | | | | | - Chiara Bernini
- European Alliance for Personalised Medicine, Brussels, Belgium
| | | | | | - Alastair Kent
- Independent Patient Advocate, London, United Kingdom
| | | | - Ivica Belina
- Coalition of Healthcare Association, Zagreb, Croatia
| | - Jan Van Meerbeeck
- Antwerp University and Antwerp University Hospital, Antwerp, Belgium
| | | | | | - Beata Jagielska
- Maria Skłodowska-Curie Institute of Oncology, Warsaw, Poland
| | - Sarah Mee
- AstraZeneca, Cambridge, United Kingdom
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Romero A, Gómez-Salgado J, Romero-Arana A, Ortega-Moreno M, Jódar-Sánchez F, Ruiz-Frutos C. Costs analysis of a training intervention for the reduction of preanalytical errors in primary care samples. Medicine (Baltimore) 2020; 99:e21385. [PMID: 32756129 PMCID: PMC7402912 DOI: 10.1097/md.0000000000021385] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND To perform a cost-error analysis based on a quasi-experimental pre-post study of the preanalytical errors in 2 hospital laboratories. The real cost and theoretical cost are defined as the cost resulting from errors with or without the training intervention. The real impact associated to the training program was estimated, calculated as the total associated to the preanalytical errors cost difference. The costs were measured using Andalusian Public Health Service fees. Cost analysis of an educational intervention presented in a previous study from 2017. Preanalytical errors were detected in the laboratories of the University Hospital Virgen de la Victoria (Málaga, Spain) and in the University Hospital Juan Ramón Jiménez (Huelva, Spain). METHODS The founded errors were divided into blood and urine samples. Univariate sensitivity analysis was used to assess how parameter uncertainty impacted on overall results. Variations of parameters between 0% and 5% were substituted into the base case. RESULTS The real impact associated with educational intervention in LAB1 was an increase of &OV0556;16,961.378, and the expected impact was an increase &OV0556;78,745.27 (difference of &OV0556;61,783.9). In LAB2, the real impact in the same period amounted to &OV0556;260,195.37, and the expected impact was &OV0556;193,905.83 (difference of -&OV0556;66,289.54). The results were different in the 2 laboratories, proving the intervention in only one of them to be more effective. CONCLUSIONS Costs analysis determined that this training intervention can provide saves in the costs, as the effectiveness of the educational sessions in reducing preanalytical errors currently results in a significant decrease of the costs associated with these errors.
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Affiliation(s)
- Adolfo Romero
- Nursing and Podiatry Department, University Hospital Virgen de la Victoria, Health Sciences School, University of Málaga, IBIMA (Institute of Biomedicine Research, Málaga), Málaga
| | - Juan Gómez-Salgado
- Department of Sociology, Social Work and Public Health, Faculty of Labour Sciences, University of Huelva, Huelva, Spain
- Safety and Health Postgraduate Programme, Universidad Espíritu Santo, Guayaquil, Ecuador
| | - Adolfo Romero-Arana
- Andalusian Public Foundation for the Biomedical Research in Malaga (FIMABIS), Málaga
| | | | - Francisco Jódar-Sánchez
- Biomedical Informatics, Biomedical Engineering and Health Economy, Institute of Biomedicine Research of Seville (IBiS), Virgen del Rocío University Hospital, University of Seville, Seville, Spain
| | - Carlos Ruiz-Frutos
- Department of Sociology, Social Work and Public Health, Faculty of Labour Sciences, University of Huelva, Huelva, Spain
- Safety and Health Postgraduate Programme, Universidad Espíritu Santo, Guayaquil, Ecuador
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