69 Utilization and Diagnostic Yield of Paraneoplastic Panel Testing at an Academic Tertiary Care Facility

Abstract

Background: The cost of healthcare in the United States has risen dramatically and now sits at almost 18% of GDP. To combat these rising costs and bend the "cost curve," an emphasis has been placed on value-based care where reimbursements are directly tied to the outcomes of patients. For more than 30 years, the paraneoplastic panel (PNP) has been a key part of the diagnostic approach for patients who present with neurological symptoms of undetermined etiology, especially those with cancer or risk factors for cancer. Like other costly, complex tests, it presents a good template for utilization optimization. Many reports have been written on the utility of PNP testing in specifc diseases (eg, motor neuron disease). However, the literature is scant on the use and utilization of the PNP for an entire hospital. Methods: We performed a one-year retrospective chart review of all PNP orders, in a 700-bed academic tertiary center in the Eastern United States. For all orders, we determined if there was a positive fnding, and if appropriate clinical actions were taken in response to the results. Results: A total of 248 samples were sent out for PNP evaluation. The cost per test panel was $871. Of the 248 samples, 27(10.8%) had a positive fnding. Six of the 27 (22.2%) had a history of malignancy (pituitary adenoma, thymic carcinoma [2], prostate adenocarcinoma, renal cell carcinoma, and squamous cell carcinoma of the tongue). Nine different autoantibodies were detected. Fifteen of the 27 (55.5%) cases were deemed to have appropriate clinical follow-up. Seven of the 27 (25.9 %, 2.8% overall) led to further action by the clinical team. Conclusions: Our expert clinicians who ordered PNP tests obtained a positive result in 11% of patients. This positivity rate suggests that the patients were appropriately selected for testing. However, in the three-quarters of patients with positive results and no history of malignancy, there was no subsequent referral to attempt to diagnose a neoplasm. These patients represent a group where appropriate response to laboratory results could improve test utility and save costs. In addition, these results can be used for comparison and to help establish utilization guidelines for PNP testing at other institutions.