Research Article| Volume 1, ISSUE 1, P3-19, March 1981

Technology Assessment in Laboratory Medicine: Rationalizing or Rationing?

  • Robert C. Rock
    Department of Laboratory Medicine The Johns Hopkins Hospital 600 North Wolfe Street Baltimore, Maryland 21205.
    Director, Clinical Laboratories, The Johns Hopkins Hospital, Associate Professor of Pathology (Laboratory Medicine), The Johns Hopkins University School of Medicine, Baltimore, Maryland
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      To determine the clinical role, if any, of a new technology in laboratory medicine, as assessment should be undertaken to validate the reliability and clinical usefulness of the technology and its cost effectiveness, and to compare it with alternative strategies. A framework for the evaluation of new technologies is presented.
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        • Analytical goals in clinical chemistry
        Their relationship to medical care. Proceedings of the Subcommittee on Analytical Goals in Clinical Chemistry, World Association of Societies of Pathology, CIBA Foundation, London, England, April 25-28, 1978.
        Am. J. Clin. Pathol. 1979; 71: 624
        • Barnett R.N.
        Medical significance of laboratory results.
        Am. J. Clin. Pathol. 1968; 50: 671
        • Benson E.S.
        Strategies for improved use of the clinical laboratory in patient care.
        in: Benson E.S. Rubin M. Logic and Economics of Clinical Laboratory Use. Elsevier/North Holland Biomedical Press, New York1978: 245-258
        • Benson E.S.
        Initiatives toward effective decision making and laboratory use.
        Hum. Pathol. 1980; 11: 440
        • Broughton P.M.G.
        • Buttolph M.A.
        • Goenlock A.H.
        • et al.
        Recommended scheme for the evaluation of instruments for automatic analysis in the clinical biochemistry laboratory.
        J. Clin. Pathol. 1969; 22: 278
        • Bunker J.P.
        Hard times for the National Centers.
        N. Engl. J. Med. 1980; 303: 580
        • Buttner J.
        • Borth R.
        • Boutwell J.H.
        • et al.
        Provisional recommendation on quality control in clinical chemistry. II. Assessment of analytical methods for routine use. International Federation of Clinical Chemistry.
        Clin. Chim. Acta. 1976; 68: F1
        • Carter P.M.
        • Davison A.J.
        • Wickings H.L.
        • et al.
        Quality and quantity in chemical pathology.
        Lancet. 1974; 2: 1555
        • Casscells W.
        • Schoenberger A.
        • Graboys T.B.
        Interpretation by physicians of clinical laboratory results.
        N. Engl.J. Med. 1978; 299: 999
        • Cole G.W.
        Biochemical test profiles and laboratory system design.
        Hum. Pathol. 1980; 11: 424
        • Conn R.B.
        Clinical laboratories. Profit center, production industry, or patient-care resource?.
        N. Engl. J. Med. 1978; 298: 422
        • Conn R.B.
        • Brynes R.K.
        Transfer of research technology to clinical practice—what are the criteria? N.
        Engl. J. Med. 1980; 302: 686
        • Curran W.J.
        Law-medicine notes. The health planners and computerized tomography: High technology, cost control, and judicial review.
        N. Engl. J. Med. 1980; 303: 626
        • Daniels M.
        • Schroeder S.A.
        Variation among physicians in use of laboratory tests. II. Relation to clinical productivity and outcomes of care.
        Med. Care. 1977; 15: 482
        • Dayhoff R.E.
        • Miller R.E.
        • Dans P.E.
        • et al.
        Approaches to computer monitoring of clinical laboratory utilization.
        in: Computer Applications in Medical Care. Institute for Electrical and Electronic Engineering, Washington, D.C.1980
        • Eisenberg J.M.
        An educational program to modify laboratory use by house staff.
        J. Med. Educ. 1977; 52: 578
        • Feinstein A.R.
        Clinical Biostatistics. C.V. Mosby Co., St. Louis1977
        • Fineberg H.V.
        Clinical chemistries: The high cost of low-cost diagnostic tests.
        in: Altman S.H. Blendon R. Medical Technology: The Culprit Behind Health Care Costs? Government Printing Office, Washington, D.C.1979: 144-165 (DHEW Publication No. PHS 79-3216.)
        • Fineberg H.V.
        • Hiatt H.H.
        Evaluation of medical practices. The case for technology assessment.
        N. Engl. J. Med. 1979; 301: 1086
        • Flagle C.D.
        Evaluation and control of technology in health services.
        in: Collen M.F. Technology and Health Care Systems in the 1980’s. Government Printing Office, Washington, D. C.1974: 213-224 (DHEW Publication (HSM) 73-3016.)
        • Galen R.S.
        • Gambino S.R.
        Beyond Normality: The Predictive Value and Efficiency of Medical Diagnoses. John Wiley, New York1975
        • Gibson R.M.
        National health expenditures, 1978.
        Health Care Financ. Rev. 1979; 1: 1
        • Griner P.F.
        Use of laboratory tests in a teaching hospital: Long-term trends. Reductions in use and relative costs.
        Ann. Intern. Med. 1979; 90: 243
        • Hardwick D.F.
        • Vertinsky P.
        • Barth R.T.
        • et al.
        Clinical styles and motivation: a study of laboratory test use.
        Med. Care. 1975; 13: 397
        • Institute of Medicine
        Computed tomographic scanning. National Academy of Sciences, Washington, D.C.1977
        • Kassirer J.P.
        • Gorry G.A.
        Clinical problem solving: A behavioral analysis.
        Ann. Intern. Med. 1978; 89: 235
        • Kassirer J.P.
        • Pauker S.G.
        Should diagnostic testing be regulated? N.
        Engl. J. Med. 1978; 299: 947
        • Lloyd P.H.
        Technical Bulletin No.
        39. A scheme for the evaluation of diagnostic kits. Ann. Clin. Biochem. 1978; 15: 136
        • Moloney T.W.
        • Rogers D.E.
        Medical technology—a different view of the contentious debate over costs.
        N. Engl. J. Med. 1979; 301: 1413
        • Murphy E.A.
        The Logic of Medicine. Johns Hopkins University Press, Baltimore1976
        • Murphy J.
        • Henry J.B.
        Effective utilization of clinical laboratories.
        Hum. Pathol. 1978; 9: 625
      1. National Committee for Clinical Laboratory Standards

        • Office of Technology Assessment
        The implications of cost-effectiveness: analysis of medical technology. Government Printing Office, Washington, D.C.1980
        • Pauker S.G.
        • Kassirer J.P.
        The threshold approach to clinical decision making.
        N. Engl. J. Med. 1980; 302: 1109
        • Perry S.
        • Kalberer J.T.
        The NIH consensus-development program and the assessment of health-care technologies. The first two years.
        N. Engl. J. Med. 1980; 303: 169
        • Schroeder S.A.
        • Showstack J.A.
        • Roberts H.E.
        Frequency and clinical description of high-cost patients in 17 acute-care hospitals.
        N. Engl. J. Med. 1979; 300: 1306
        • Sunderman Jr., F.W.
        Current concepts of “normal values,” “reference values,” and “discrimi nation values” in clinical chemistry.
        Clin. Chem. 1975; 21: 1873
        • Thibault G.E.
        • Mulley A.G.
        • Barnett G.O.
        • et al.
        Medical intensive care: Indications, interventions, and outcomes.
        N. Engl. J. Med. 1980; 302: 938
        • Tonks D.B.
        A study of the accuracy and precision of clinical chemistry determinations in 170 Canadian laboratores.
        Clin. Chem. 1963; 9: 217
        • Weinstein M.C.
        • Stason W.B.
        Foundations of cost-effectiveness analysis for health and medical practices.
        N. Engl. J. Med. 1977; 296: 716
        • Wertman B.G.
        • Sostrin S.V.
        • Paulova Z.
        • et al.
        Why do physicians order laboratory tests? A study of laboratory test request and use patterns.
        J.A.M.A. 1980; 243: 2080
        • Westgard J.O.
        • Hunt M.R.
        Use and interpretation of common statistical tests in method-comparison studies.
        Clin. Chem. 1973; 19: 49
        • Westgard J.O.
        • Carey R.N.
        • Wold S.
        Criteria for judging precision and accuracy in method development and evaluation.
        Clin. Chem. 1974; 20: 825
        • Westlake G.E.
        • Lundberg G.
        Cost containment in the clinical laboratory—to be or to seem to be — or when is a non-test a test?.
        J.A.M.A. 1980; 243: 1659