Data from: Extent and cost of inappropriate use of tumour markers in patients with pulmonary disease: a multicentre retrospective study in Shanghai, China

Objectives: The currently implemented healthcare reform in China requires substantial capital investment. Although overtreatment results in serious waste, inappropriate laboratory use is widespread, and overuse of tumor markers (TMs) has attracted increasing attention. Design: Retrospective study. Setting: The respiratory, thoracic surgery, and oncology departments of three hospitals in Shanghai, from 2014 to 2015. Participants: Patients with chronic obstructive pulmonary disease (COPD) and primary bronchogenic lung cancer (PLC). Based on clinical guidelines and physician experience, the criteria of suitability of TM examinations were determined, and the number, cost, and proportion of inappropriate TM requests were analyzed. Results: The area under the receiver operating characteristic (ROC) curve for CEA+CYFRA211+SCC+NSE in COPD and PLC patients was 0.813, in accordance with the cost-effectiveness principle, indicating good clinical and health economics values. In the 2706 patients, 12,496–16,956 (58.27–79.06%) of TM requests were inappropriate. Furthermore, the involved expense was 650,200–1,014,156 yuan, accounting for 7.69–12.00% of examination expenses, and 1.35–2.11% of hospitalization costs. Conclusions: We found that the inappropriate use of TMs was widespread for patients with pulmonary disease. Clinicians should use TMs strictly according to the guidelines to effectively manage laboratory resources and control costs.

研究目标：我国当前实施的医疗卫生改革亟需巨额资金投入。尽管过度医疗已造成严重资源浪费，但不恰当的实验室检验应用仍广泛存在，而肿瘤标志物（tumor markers, TMs）的过度使用也日益引发关注。
研究设计：回顾性研究。
研究场景：2014年至2015年，上海市三家医院的呼吸内科、胸外科与肿瘤科。
研究对象：慢性阻塞性肺疾病（chronic obstructive pulmonary disease, COPD）与原发性支气管肺癌（primary bronchogenic lung cancer, PLC）患者。结合临床指南与医师临床经验，确定肿瘤标志物检验的适宜判定标准，并分析不恰当的肿瘤标志物检验申请的数量、花费及其占比。
研究结果：针对上述两类患者，癌胚抗原（carcinoembryonic antigen, CEA）+细胞角蛋白19片段（cytokeratin 19 fragment, CYFRA211）+鳞状细胞癌抗原（squamous cell carcinoma antigen, SCC）+神经元特异性烯醇化酶（neuron-specific enolase, NSE）的受试者工作特征（receiver operating characteristic, ROC）曲线下面积为0.813，符合成本效益原则，展现出良好的临床与卫生经济学价值。在2706例患者中，共有12496~16956项（占比58.27%~79.06%）肿瘤标志物检验申请为不恰当申请。涉及的检验花费共计650200~1014156元，占检验总费用的7.69%~12.00%，占住院总费用的1.35%~2.11%。
研究结论：本研究发现，肺部疾病患者中肿瘤标志物的不规范使用情况十分普遍。临床医师应严格遵循指南开展肿瘤标志物检验，以实现实验室资源的有效管理与医疗成本的合理管控。