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.

研究背景与目的：中国当前推行的医疗改革需要巨额资金投入。过度诊疗造成严重的医疗资源浪费，实验室检查应用不规范的情况频发，肿瘤标志物（tumor markers, TMs）的过度使用也日益受到关注。
研究设计：回顾性研究。
研究地点：2014年至2015年，上海市3家医院的呼吸内科、胸外科及肿瘤科。
研究对象：慢性阻塞性肺疾病（chronic obstructive pulmonary disease, COPD）患者与原发性支气管肺癌（primary bronchogenic lung cancer, PLC）患者。本研究依据临床指南与医师临床经验，确定肿瘤标志物检查的适宜性判定标准，并分析不规范开具的肿瘤标志物检查申请的数量、成本及占比。
研究结果：针对慢性阻塞性肺疾病与原发性支气管肺癌患者，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，具备良好的临床与卫生经济学价值。在2706例患者中，共有12496~16956项肿瘤标志物检查申请存在不规范情况，占比达58.27%~79.06%。此外，涉及的检查费用总计650200~1014156元，占总检查费用的7.69%~12.00%，占总住院费用的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较为普遍。临床医师应严格遵循临床指南开展肿瘤标志物检查，以有效管控实验室资源并控制医疗成本。