Impact of the introduction of a guideline on the targeted detection of hereditary haemochromatosis.
BACKGROUND
In 1998 a clinical guideline for the targeted, accurate and early detection and treatment of HFE-related hereditary haemochromatosis (HH), which comprises a test for the causative HFE-gene mutations, was introduced in our outpatient department.


METHODS
The impact of this guideline was evaluated retrospectively. Data were acquired from medical records of patients with discharge diagnosis codes suggestive of HH (n=878 patients), obtained from a period before (n=422) and after guideline introduction (n=456).


RESULTS
Combined measurements of serum transferrin saturation and serum ferritin rose from 12.2% (n=53) to 29.5% (n=138, p<0.001), leaving 70% of the patients eligible for HH not tested for iron parameters. The HFE-gene mutation detection test was correctly used in II (40.7%) of 27 tested patients and improperly interpreted in six (22.2%) of these 27 patients. Five new HH patients were diagnosed before and 13 after introduction. Seven of these 13 patients appeared to be incorrectly diagnosed, due to misinterpretation of laboratory results. Diagnostic costs of case detection for each accurately diagnosed patient were euro 2380 before and euro 2600 after introduction of the guideline.


CONCLUSIONS
Evaluation of the introduction of a practical guideline for targeted HH detection reveals a low compliance with the guideline, resulting in both a small percentage of patients tested for HH and overdiagnosis of HH. Therefore, the introduction of the guideline should be combined with a more appropriate implementation strategy which includes education on its most critical points, i.e. the indication and interpretation of the iron parameters and the HFE genotype.
Jacobs
E M G
EM
Department of Clinical Chemistry (564), Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. e.jacobs@aig.umcn.nl
Meulendijks
C F M
CF
Elving
L
L
van der Wilt
G J
GJ
Swinkels
D W
DW
D001706:Biopsy; D003365:Costs and Cost Analysis; D005260:Female; D005293:Ferritins / Q000097:blood; D005820:Genetic Testing; D005838:Genotype; D019983:Guideline Adherence; D006432:Hemochromatosis / Q000175:diagnosis / Q000191:economics / Q000235:genetics*; D006801:Humans; D008099:Liver / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009154:Mutation; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D014168:Transferrin / Q000032:analysis
D014168:Transferrin; D005293:Ferritins