P-78 Autoimmune Diagnostics at Georgetown Public Hospital Corporation - Does the Demand Necessitate a Feasibility Study to Transition to In-house Testing?

Methods: 900 patient records in 2023 were reviewed, covering age, gender, test date/type/results, and costs. Physicians’ perceptions were surveyed using a questionnaire. Costs and positivity rates were categorised into ranges and levels. Statistical analysis involved Chi-Square Test of Independence and Spearman’s Rank Correlation.

Results: 2048 tests were analysed, with 81% from females, mostly in the ≤20 (14%) and 31-40 (21%) age groups. ANA, (26%), Anti-CCP, (9%), Anti-dsDNA, (9%) were the three most requested tests. GPHC, spent 51,696,452 GYD (258,482 USD), (59%) on the top five. Positive 17%, negative (82%) and indeterminate (1%). Highest positivity rates included ANA (40%); Anti CCP (12%) and Lupus Anticoagulant Antibody (LAA) (11%). Most costs (91.5%) were for tests with low positivity rates, totaling 47,299,732 GYD (236,498.66 USD). Logistic regression showed that age, test types, and price range were statistically significant predictors of test results. The 41-45 age group (P=0.012) and LAA (P=0.031) and TSHR (P=0.04) tests were more likely to yield positive results. Tests within higher price ranges also had higher chances of positive results (P ≤ 0.05). Among the 18 responding physicians, there was no statistical correlation between designation nor years of practice with testing practices (P>0.05). They considered ANA (89%) and Anti ds DNA (78%) most useful. Test choice depended on clinical presentation. Most were unaware of test costs (72%) and recognised tests were subcontracted (94%). They were dissatisfied with the 4-week turnaround time (TAT) and advocated in-house testing to improve TAT.

Conclusion: The demand for autoimmune testing exists and a feasibility study is recommended. Tests suggested for pilot in-house testing: ANA, Anti CCP, Anti dsDNA, Anti sm Ab, c-ANCA, LAA, and RF