This is all covered in the Keele Benchmarking report 2012-13
Michael
Dr. C . M. Colley
Consultant Chemical Pathologist
Great Western Hospital
Swindon SN3 6BB
-----Original Message-----
From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Smith Sophy - Clinical Scientist
Sent: 16 June 2014 16:07
To: [log in to unmask]
Subject: Quick poll: first line TFTs
Dear all,
I am due to talk to some GPs shortly about thyroid function testing amongst other things, and would like to do a quick survey of first line TFT testing strategy. This subject has been touched upon before (e.g. thread below) but I can't find a similar straw poll! I am interested in whether you do:
First line TSH only
First line FT4 and TSH
Other, and if so, what.
Many thanks.
Dr Sophy Smith
Clinical Biochemist
Blood Sciences
Queen Alexandra Hospital, Portsmouth
023 9228 6397
-----Original Message-----
From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Jonathan Kay
Sent: 06 December 2013 09:44
To: [log in to unmask]
Subject: Evidence-Based Laboratory Medicine: thyroid investigations in primary care
Good question, Stuart. But look what happened when we tried to debate it earlier this year. This is a perfect opportunity for evidence-based laboratory medicine.
Jonathan
> I thought that Sharon's post would stimulate the debate, not silence it.
>
> From an EBLM point of view I can see three constructive responses:
>
> 1 Criticism of the model used by Sharon and Brian.
>
> 2 Criticism of the input values used in the analysis.
>
> 3 A prospective trial of different approaches.
>
> And two that don't move us on:
>
> 4 Ignoring the results of the cost-effectiveness analysis
>
> 5 Preferring anecdotal findings to the results of the cost-effectiveness analysis.
>
> Here's a convenient hierarchy for assessing levels of evidence that includes both "Diagnosis" and "Economic and decision analysis":
> http://www.cebm.net/?O=1025
>
> Jonathan
> We carried out a pilot study looking into this at Oxford and made an estimate of ICER based on in-house data on workload figures, unit test costs etc. as well as data from the literature on prevalence, QoL in treated and untreated hypopit patients and differences in mortality rates. Based on our calcs, FT4 as a first-line test for GPs was deemed not to be cost-effective (ICER=£39,000/QALY; NICE use a cut-off of about £20,000/QALY). A few assumptions had to be made, so the ICER we calculated is an estimate. We also performed sensitivity analyses to look what effect varying the different parameters had on the ICER (as a % change) e.g. halving the test cost for FT4.
>
> This was presented by Dr Shine at the ACB SR Spring meeting held in April and also as a poster at this year's FOCUS meeting. If anyone would like a copy of the pdf I am happy to email it.
>
> Sharon
>
> Sharon Colyer
> Pre-registration Clinical Biochemist
> Clinical Biochemistry
> Royal Free Hospital
> Ext 38856
On 6 Dec 2013, at 09:31, JONES Stuart (Pathology) (RF4) BHR Hospitals <[log in to unmask]> wrote:
> Only just got round looking at this in detail. TFT data is particularly interesting - far more variation in FT4 testing than TSH. Must largely be a reflection of differing laboratory practice i.e. TSH only first-line vs TSH+FT4 vs whatever the GP asks for? Isn't it about time we tried to standardise our approach around best evidence?
>
> Stuart
>
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