Retrospective evaluation of a local protocol used to enhance laboratory savings through minimising the performance of alkaline phosphatase isoenzyme analysis

Haji, Saliha MI, Chipchase, Allison, Fraser, William D and Gomez, Javier (2019) Retrospective evaluation of a local protocol used to enhance laboratory savings through minimising the performance of alkaline phosphatase isoenzyme analysis. Annals of Clinical Biochemistry, 56 (2). pp. 298-301. ISSN 0004-5632

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    Abstract

    Background: Alkaline phosphatase (ALP) isoenzyme analysis is an expensive and time-consuming laboratory test. We evaluated the effect of a locally-derived screening algorithm for ALP isoenzyme requests on the number of ALP isoenzyme analyses performed, laboratory cost, and patient care. Method: 110 ALP isoenzyme analysis requests from the year 2015 were reviewed and subsequent ALP concentrations were monitored over a 2-year period, to determine if the decision of performing/not performing ALP isoenzyme analysis, based on the algorithm, had an impact on patient care and laboratory cost. All ALP isoenzyme analysis requests with 2 consecutive elevated ALP concentrations (>upper limit of reference interval) were screened and, subject to the gamma glutamyl transferase (GGT) being within the reference interval, either Bone ALP or 25 hydroxyvitamin D (25-OHD) was measured depending on the age of the patient. Results: Compliance with this algorithm led to the normalisation of subsequent serum ALP in 97% of patients without requiring ALP isoenzyme analysis. The cost of performing Bone ALP and 25-OHD in-house was £778.50 whilst the cost of performing ALP isoenzyme analysis would have been £3040. This resulted in a laboratory saving of £2261.50. Conclusions: Implementation of this algorithm led to a significant reduction in ALP isoenzyme analysis, without compromising patient care. Total savings could be increased if 25-OHD was used as a first-line test, for all patients with an elevated ALP and a normal GGT regardless of age. This algorithm is cost-effective and can be implemented in laboratories with 25-OHD assay.

    Item Type: Article
    Uncontrolled Keywords: alkaline phosphatase isoenzyme,bone-specific alkaline phosphatase,25 hydroxyvitamin d,gamma glutamyl transferase,cost benefit
    Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
    Depositing User: LivePure Connector
    Date Deposited: 20 Dec 2018 15:31
    Last Modified: 13 Apr 2019 20:30
    URI: https://ueaeprints.uea.ac.uk/id/eprint/69404
    DOI: 10.1177/0004563218817571

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