BACKGROUND: Current guidelines and practices for thyroid function testing are strongly affected by the usually higher @entity1 billing charges and Medicare reimbursement for thyrotropin (TSH) vs free @entity1955 (FT4) tests, despite their comparable direct costs. OBJECTIVE: Due to recently reduced laboratory costs, to reexamine the effectiveness and cost of alternative test sequences. METHODS: Alternative test sequences involve using the TSH test first, followed, if the TSH test result is abnormal, by the FT4 test; the FT4 test first, followed by the TSH test; and doing both tests together. We applied these strategies to consecutive @entity1 referred for any thyroid function test to a health maintenance organization, a multispecialty fee-for-service group, a military hospital, and a commercial laboratory. Effectiveness was determined from a literature review. The cost was determined from direct costs and the distribution of diagnostic categories. RESULTS: The TSH and FT4 tests have similar sensitivities for detecting clinical @entity1378 and @entity1375 . The TSH test detects subclinical function, and it monitors @entity1955 treatment better; the FT4 test detects @entity1375 , and it monitors rapidly changing function better. Direct costs for both were equal, but charges for the TSH test were higher. The average direct cost per @entity1 , starting with the FT4 test, was  4.61; starting with the TSH test,  5.90; and starting with both tests together,  6.50. Medicare reimbursements correlated poorly with costs. CONCLUSIONS: Starting with the TSH test and reflexing to the FT4 test provides a better first-line all-purpose sequence than the reverse. In managed care settings, the slightly higher direct cost of this approach is offset by greater clinical effectiveness. In fee-for-service settings, cost differences can be nearly eliminated by equalizing TSH and FT4 charges to reflect current direct-cost realities. Obtaining both tests together overcomes the disadvantages of each at a slightly higher direct cost.

Alternative sequences of thyrotropin and free XXXX assays for routine thyroid function testing. Quality and cost.

@entity1 :: ('9606', 'Species') :: ['patients', 'patient'] @entity1375 :: ('MESH:D007037', 'Disease') :: ['hypothyroidism', 'central hypothyroidism'] @entity1955 :: ('MESH:D013974', 'Chemical') :: ['thyroxine'] @entity1378 :: ('MESH:D006980', 'Disease') :: ['hyperthyroidism']
@entity1955 :: (MESH:D013974,Chemical) :: ['thyroxine']
