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Tiroid Fonksiyon Testi İstemlerinin Algoritmaya Uygunluk ve Fiyat Etkinlik Açısından Değerlendirilmesi

Evaluation of the Requests for Thyroid Function Test According Algorithms and Cost Effectivity

Journal Name:

  • Abant Tıp Dergisi

Publication Year:

  • 2013
DOI: 
doi: 10.5505/abantmedj.2013.77699

Key Words:

Keywords (Original Language):

Author NameUniversity of AuthorFaculty of Author
Abstract (2. Language): 
Objective: Serum thyroid stimulating hormone (TSH) level measurement is most commonly used test in the diagnosis and monitoring of patients with all forms of clinical hyper-thyroidism and hypothyroidism. The guidelines recommend that serum free triiodothyronine (FT3) and free tetraiyodoti-ronin (FT4) levels request if only in patients with TSH levels suppressed or elevated. The aim of this study was to analyze the ordering pattern for thyroid function tests and analysis of cost effectivity. Method: In this study, we scanned laboratory information system for the date’s 01.01.2012-31.12.2012. TSH, FT3 and FT4 levels estimated patients grouped according to their request (group 1: TSH, group 2: TSH + FT3, 3.Group: TSH + FT4, 4.Group: TSH + FT3 + FT4). Each group was analyze for reference range values for TSH. It divided sub-groups hypo-thyroidic, hyperthyroidic, normothyroidic. Each sub-group analyzed appropriateness of the clinical request for algo-rithm. Results: We were found 24.691 TSH, 18.432 sT4, 14.537 sT3 tests in the specified date range. Combination of ordered tests were identified in 5990 patients TSH, 269 patients in group 2, 4164 patients in group, 14 268 patients in group 4. As a result of the analyze, we found that there is additional cost of 25 505 FT3 and FT4 tests in patients with TSH values normothyroidic. These tests cost according Health Commu-nication Application is 114 772 TL. Conclusion: In the diagnosis and follow-up of thyroid gland dysfunction must be take into account the algorithms. The results indicate that the thyroid profile request is used more widely than only TSH which recommended by the guidelines for screening. Improving the appropriateness of ordering of tests related to thyroid function will definitely be more cost effective.
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Abstract (Original Language): 
Amaç: Serum tiroid stimule edici hormon (TSH) düzeyi ölçü-mü, klinikte hipertiroidi ve hipotiroidilerin tüm formlarının tanısında ve takibinde en yaygın olarak kullanılan testtir. Kılavuzlarda, serum serbest triiyodotironin (sT3) ve serbest tetraiyodotironin (sT4) düzeyinin, ancak TSH düzeyi baskı-lanmış veya yükselmiş olan hastalarda istenmesi tavsiye edilmektedir. Biz bu çalışmada tiroid hastalıklarının tanı ve takibinde istenilen testlerin, ne ölçüde klinikte öngörülen algoritmayı yansıttığını ve mevcut durumun fiyat etkinliğini sağlamadaki durumunu araştırdık. Yöntem: Bu çalışmada hastanemiz laboratuvar bilgi siste-minde 01.01.2012-31.12.2012 tarihleri arasında kayıtlı olan verileri taradık. TSH, sT3 ve sT4 düzeyi çalışılmış olan hasta-ları istemlerine göre gruplandırdık (1.grup: TSH, 2.grup: TSH+sT3, 3.grup: TSH+sT4, 4.grup: TSH+sT3+sT4). Her bir grubu TSH referans aralık değerlerine göre hipotiroidi, nor-motiroidi ve hipertiroidi alt gruplarına ayırdık. Her bir alt grubun yapılan klinik istemlerinin algoritmaya uygunluğunu analiz ettik. Bulgular: Belirlenen tarih aralığında çalışılmış 24.691 TSH, 18.432 sT4, 14.537 sT3 sonucu olduğunu bulduk. Sadece 5.990 hastada tek başına TSH istemi yapılmış olduğu görül-dü. 2.grupta 269 hasta, 3.grupta 4.164 hasta, 4.grupta ise 14.268 hasta tespit edildi. TSH’ı normotiroidik değerlere sahip olan hastalarda yapılan analizler sonucunda, berabe-rinde istenmiş olan 25.505 adet sT3 ve sT4 testlerinin ek bir maliyet oluşturduğu saptandı. Bu testlerin Sağlıkta Uygulama Tebliği (10.01.2013) esaslarına göre kurumlara geri ödemesi yapılan parasal mali karşılığının 114.772 TL olduğu saptandı. Sonuç: Tiroid bezi işlev bozukluklarının tanısında ve takibin-de izlenmesi gereken algoritmalara uyulmalıdır. Sonuçlar, kılavuzların önerdiği şekilde sadece TSH isteminin yapılması gereken olgularda, beraberinde sT3 ve/veya sT4 testleri isteminin daha yaygın olarak kullanıldığını göstermektedir. Tiroid fonksiyon testi istemlerinde önerilen algoritmaya uyumun artmasının fiyat etkinliği artıracağını düşünmekte-yiz.
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