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Re: Pap smears: Why are we changing?? From: jay kulkin (jkulkin@mindspring.com) Thu Dec 25 18:36:08 1997 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: jay kulkin: "Re: Health Insurance/HMO's" Previous message: Robert J. Woolley: "Re: Health Insurance/HMO's" Maybe in reply to: ATFSOCCER: "Pap smears: Why are we changing??" Next in thread: Garry E. Siegel, M.D.: "Re: Pap smears: Why are we changing??" Reply: Garry E. Siegel, M.D.: "Re: Pap smears: Why are we changing??" I've reviewed this issue extensively recently. When a new laser comes out to be used in the OR, do we charge more for doing the same procedure with a different instrument. I think the same applys to thin prep and the pricing to the lab. Should this test, which has lots of company claims but minimal scientific evidence supporting it be so expensive. Is there a cost benefit advantage? First of all, most authorities believe the thinly prepared slides are easier for cytotechs to read. Stands to reason if there is less debris on the slide. The reason thin prep is so expensive is the solution and the filters to hold the cells and filter them are proprietary. This means they can charge whatever the market will bear. Secondly, the FDA has not approved the thinprep slides to be read on the autopap machines, which many of the large labs like Smith-Kline are using. They committed to these system before thinPrep had FDA approval. This is significant as autopap is the only automated pap device approved by CLIA for the labs to use. Concensus is that then FDA will approve ThinPrep slides for autopap in the near future. Now back to the main issue- Is ThinPrep better or not. I am told there will be an adjudicated article in ACTA cytologica in January that will reveal a SMALL difference but no where near the claims of CYTYC. Don't take that as gospel-let's wait for the article in a few weeks. Also, HCFA is going to assign a reimbursement for the ThinPrep cpt code in the next several weeks which will start to create a more reasonable market. CYTYC stock has been languishing. Let's see what happens. Jay At 05:31 PM 12/25/97 -0600, you wrote: >We have had extensive discussions with both our pathologists as well as the >people from Cytyc (the company that markets ThinPrep). > >There have been some studies that show that the ThinPrep reduces the number >of unsatisfactory smears due to debris, inflammation, etc. There are some >other theoretical advantages also, such as more accurate sampling on the >slide of the cell population, cells saved for possible viral typing, etc. >We have not yet been convinced that the accuracy, as defined by correlation >with tissue samples, is as good or better. > >I don't think the answer is in yet regarding the ASCUS and LSIL. The real >issue is your lab's rate of ASCUS, and their percentage of "real disease" >(HSIL) in the ASCUS group. > >I personally think ThinPrep will probably become standard at some time in >the future, but I'm not sure we're there yet. > >BTW, the variability of pricing in our area is amazing. The two hospital >labs that are doing ThinPreps are charging $28-$38. One lab charges an >extra $10 if the slide has to be reviewed by a Pathologist. Traditional 1 >or 2 slide paps cost anywhere from $30 - $73. I recently found out that the >main large commercial lab we deal with charges $73 for a patient self-pay >pap smear. > >Does anyone else think that is as outrageous as I do??? > >Also, away from the thinprep issue, are people doing one or two slide pap >smears??? > >At 11:21 PM 12/18/97 -0600, you wrote: >> >>Our pathology department informed us they will be switching to the new >>"Thin Prep" for evaluation of the pap smears. >> >>They were not sure if going to this screen would allow us to reduce the >number >>of colposcopies that are done for ASCUS and LSIL. >> >>I still have not figure out why we should replace the traditional pap smear >>a screen that costs an additional $20 more. With 50 million paps done >>annually >>in the US we are looking at about 1 billion dollars in cost to attempt to >save >>the 14000 women who develop cervical cancer each year???? >> >>I must be missing something in my logic and look forward to some of my >>colleagues correcting me. >> >>Andy Folley MD FACOG >> >Larry R. Glazerman, M.D. >Valley Ob-Gyn Associates >Allentown Pa >glazerman@enter.net > Next message: jay kulkin: "Re: Health Insurance/HMO's" Previous message: Robert J. Woolley: "Re: Health Insurance/HMO's" Maybe in reply to: ATFSOCCER: "Pap smears: Why are we changing??" Next in thread: Garry E. Siegel, M.D.: "Re: Pap smears: Why are we changing??" Reply: Garry E. Siegel, M.D.: "Re: Pap smears: Why are we changing??"

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