Withholding Reflex HPV Status: Diagnostic and Financial Implications
CM Bradford, CM Mitchell, NR Wadhwani, A Salhadar. Loyola University Medical Center, Maywood, IL
Background: No previous studies have directly examined how the information made readily available to the pathologist at the time of sign-out impacts the ASC-US and reflex HPV (rHPV) positivity rates of an institution. Specifically, does withholding the knowledge of whether the patient has a rHPV test (rHPVt) ordered have an impact on the diagnosis, and therefore should institutions set up the flow of their case sign-outs to include or exclude this information? Our department invariably provides on the requisition sheet of PAP smears whether the patient has a rHPVt ordered, which accounts for 21% of all of the HPV testing performed at our institution.
Design: To determine whether the ordering status of a rHPVt should be made available at the time of case sign-out, this knowledge was withheld from the pathologist during sign-out for a study period of six weeks. The ASC-US and positive rHPV rates were then compared from the study period to the rates obtained during the control period, defined as the same six-week interval the prior year.
Results: During the study period, 2713 PAP smears were reviewed, of which 215 (7.9%) were signed out as ASC-US, with an ASC-US to LSIL ratio of 1.3. Of these, 79 had rHPVt were ordered, of which 35 (44.3 %) were positive. During the control period, 3362 PAP smears were reviewed, with 301 (9.1%) diagnosed as ASC-US, and an ASC-US to LSIL ratio of 1.26. Of these, there were 105 rHPVt, of which 32 (30.5%) were positive. Thus, withholding the rHPVt ordering status resulted in a higher HPV positive predictive value for ASC-US diagnoses.
Conclusions: The lower rHPV positivity rate during the control period may be attributed to overcalled diagnoses, in order to give the patient the benefit of a rHPVt, thus diluting the ASC-US category with cases which are negative. Given the direct cost to the patient for HPV testing at our institution is $70.00, this practice leads to financial waste for the healthcare system. Comparing our study period to the control period's positive rHPVt rates, and assuming similar patient demographics, the financial waste approximates $8,805.77 annually for our institution. As healthcare costs and its impact on patient care is at the forefront of both political and healthcare system discussions, it is beneficial to set-up practices in such a way that will not only decrease costs, but also improve patient care. Thus, it would behoove departments to restrict knowledge regarding the rHPVt ordering status from cytopathologists during sign-out, in order to prevent unnecessary influence on the final diagnosis.
Tuesday, March 23, 2010 9:30 AM
Poster Session III # 78, Tuesday Morning