Complete blood counts, liver function tests, and chest x-rays as routine screening in XXXX : value added or just cost?

@entity5 @entity1 @entity0
UNASSIGNED: Current National @entity5 Network guidelines for @entity0 staging include pre-treatment complete blood count (CBC) and liver function tests (LFT) to screen for occult metastatic disease. To date, the relevance of these tests in detecting metastatic disease in asymptomatic @entity1 with @entity0 (Stage I/II) has not been demonstrated. Although chest x-rays are no longer recommended in the NCCN guidelines, many centers continue to include this imaging as part of their screening process. We aim to determine the clinical and financial impact of these labs and x-rays in the evaluation of @entity0 @entity1 . A single institution IRB-approved retrospective chart review was conducted of @entity1 with biopsy-proven @entity0 treated from January 1, 2005-December 31, 2009. We collected @entity1 demographics, clinical and pathologic staging, chest x-ray, CBC, and LFT results at the time of referral. @entity1 were stratified according to radiographic stage at the time of diagnosis. We obtained Medicare reimbursement fees for cost analysis. From 2005 to 2009, 1609 @entity1 with biopsy-proven @entity0 were treated at our institution. Of the 1082 @entity1 with radiographic stage I/II disease, 27.3  % of @entity1 had abnormal CBCs. No additional testing was performed to evaluate these abnormalities. In the early-stage population, 24.7  % of @entity1 had elevated LFTs, resulting in 84 additional imaging studies. No metastatic disease was detected. The cost of CBC, LFTs and chest x-rays was  110.20 per @entity1 , totaling  106,410.99. Additional tests prompted by abnormal results cost  58,143.30 over the five-year period. We found that pre-treatment CBCs, LFTs, and chest x-rays did not improve detection of occult metastatic disease but resulted in additional financial costs. Avoiding routine ordering of these tests would save the US healthcare system  25.7 million annually.
