title: Cost and Efficacy Assessment of an Alternative Medication Compliance Urine Drug Testing Strategy.
abstract: This study investigates the frequency at which quantitative results provide additional clinical benefit compared to qualitative results alone. A comparison between alternative urine drug screens and conventional screens including the assessment of cost-to-payer differences, accuracy of prescription compliance or polypharmacy/substance abuse was also included.
  
  
  
  In a reference laboratory evaluation of urine specimens from across the United States, 213 urine specimens with provided prescription medication information (302 prescriptions) were analyzed by two testing algorithms: 1) conventional immunoassay screen with subsequent reflexive testing of positive results by quantitative mass spectrometry; and 2) a combined immunoassay/qualitative mass-spectrometry screen that substantially reduced the need for subsequent testing.
  
  
  
  The qualitative screen was superior to immunoassay with reflex to mass spectrometry in confirming compliance per prescription (226/302 vs 205/302), and identifying non-prescription abuse (97 vs 71). Pharmaceutical impurities and inconsistent drug metabolite patterns were detected in only 3.8% of specimens, suggesting that quantitative results have limited benefit. The percentage difference between the conventional testing algorithm and the alternative screen was projected to be 55%, and a 2-year evaluation of test utilization as a measure of test order volume follows an exponential trend for alternative screen test orders over conventional immunoassay screens that require subsequent confirmation testing.
  
  
  
  Alternative, qualitative urine drug screens provide a less expensive, faster, and more comprehensive evaluation of patient medication compliance and drug abuse. The vast majority of results were interpretable with qualitative results alone indicating a reduced need to automatically reflex to quantitation or provide quantitation for the majority of patients. This strategy highlights a successful approach using an alternative strategy for both the laboratory and physician to align clinical needs while being mindful of costs.
authors.affiliation: Department of Pathology, University of Utah School of Medicine, Salt Lake City, Utah, USA.|Department of Pathology, Primary Children’s Hospital, Salt Lake City, Utah, USA.|Intermountain Healthcare Central Laboratory, Murray, Utah, USA.
authors.forename: Kelly
authors.initials: K
authors.lastname: Doyle
authors.affiliation: Department of Pathology, University of Utah School of Medicine, Salt Lake City, Utah, USA.|ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, Utah, USA.
authors.forename: Frederick G
authors.initials: FG
authors.lastname: Strathmann
mesh_terms: D006801:Humans; D007118:Immunoassay; D055118:Medication Adherence; D015813:Substance Abuse Detection / Q000379:methods*; D053719:Tandem Mass Spectrometry; D016482:Urinalysis / Q000379:methods*
keywords: Pain Management; Urine Drug Testing; Alternative Drug Screen; Chronic Pain; Compliance