Whenever I am thinking about a new test Y, which is superior to the old (incumbent) one X, but costs more money, then the first thing I do is calculate the “disease budget”. i.e. I will find out the cost of our current test to diagnose that condition (and any other related tests) and multiply it by the number of tests we do to get the total amount of money spent on that specific disease/infection.
I can then work out how many tests we can perform with new test Y, and consider implementing selective testing criteria in order to focus testing on those patients that most require it.
Short of getting more money from lab funders for the “disease budget”, which is occasionally necessary, but very difficult to achieve , this is one of the few ways that we can introduce better (but more expensive) tests into our armoury. (Another possible route is utilising other disease budgets which have become redundant, i.e. rotavirus testing dramatically decreased due to childhood vaccination, so the money used for rotavirus testing could be used to fund the diagnosis of another faecal pathogen.)
We know that a combination of poor sensitivity and long turnaround times affects a lot of the traditional tests that we currently use in the microbiology department.
But it is not good enough to simply say, “These new tests are just too expensive for our budget”.
We owe it to our patients to play the system and work out ways of getting better, albeit more expensive tests on to the menu.
I prefer to use good tests well, on the right patients, and where real-time results can make real-time differences to patient management.
When strict clinical “qualifying” criteria are set up for certain tests, there will always be a few grumbles from requestors “Why can’t my patient get test Y”. This is when the 3Es, empathy, education, and explanation of the criteria are required. Even then, you can be sure that you will never keep everybody happy…
It is very rarely that we, in the microbiology department, audit how often the hundreds of results that we report out actually make a real time difference to the patients.
I suspect we shy away from this type of audit because the results would probably scare the living daylights out of us, and our funders…
Quality, not quantity.