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Sonul Mehta, Gustavo Corrales, Michael Summerfield; Diagnostic and Economic Yield of the Nonspecific Laboratory Work-up of Uveitis. Invest. Ophthalmol. Vis. Sci. 2011;52(14):1480.
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There is an extensive differential for the causes of anterior uveitis. A battery of diagnostic tests are often conducted to help identify a specific etiology; however, a nonspecific approach to the laboratory work-up for anterior uveitis can be both costly and inefficient. To the best of our knowledge, there has been no reported studies in the US that evaluate the cost-effectiveness and diagnostic yield of a nonspecific approach to the laboratory work-up for anterior uveitis in an inner city hospital in the US.
This retrospective chart review included 100 consecutive patients with a new diagnosis of anterior uveits. Patients with a diagnosis of traumatic, post-operative, or HSV related anterior uveitis were excluded. Laboratory findings were classified as normal or abnormal and significant or not significant. Laboratory workup performed for patients included the following tests: CBC, ESR, CRP, HLA-B27. RPR, FTA-ABS, ACE level, Lyme titer, Toxoplasmosis titer, PPD, urinalysis, Chest X-ray. The total costs for all laboratory tests and cost per significant finding were calculated.
The demographics of the patient population studied included mean age 49.4 years, 54% female, and 46% male. The overall percent of patients with at least one abnormal laboratory test result was 64%. ESR, CRP, and Urinanalysis had a diagnostic yield of 0%. CBC, HLA-B27, Lyme titer, PPD, and CXR had a diagnostic yield of less than 10%. RPR, FTA-BS, ACE levels, and Toxoplasmosis titer had the highest diagnostic yield in the inner-city patient population studied. Total cost of all laboratory studies performed was $59,570. Cost per clinically significant and relevant finding was $1805. Instead if a targeted approach to laboratory work-up had been employed, the projected total cost of all laboratory studies would be $29,072, and the cost per significant finding would be $632.
A nonspecific approach to the laboratory work-up in the initial diagnosis of uveitis is both inefficient and cost-intensive.
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