The economic appropriateness of laboratory tests

While clinicians increasingly evaluate the way that they treat patients, there has been scant emphasis (particularly in Europe) on the way diagnostic tools are chosen. This means that third-party payers are often reluctant to reimburse physicians or hospitals for diagnostic tests, not because the tests are unsafe or inaccurate but simply because they are perceived to lack substantial cost-benefit. So far, there have been few well-conducted trials on the clinical and economic benefits of laboratory tests. A good example is toxoplasmosis screening in pregnancy. Physicians want it for their patients, but in Germany (unlike France) the third-party payers have so far refused to finance the tests. There has been no comprehensive investigation to evaluate the benefits and costs of such screening. We need to broaden the perspective of economic evaluation from treatment to diagnosis, helping clinicians to make informed choices about the best use of modern technology in patient management and disease prevention. The goal of this article is to promote discussion between providers and purchasers on the value of laboratory testing.