#USA #Smithfield #ALCOR Scientific #ESR Test #CRP Test

Introduction

The healthcare industry is continually searching for ways to reduce costs while maintaining effective patient care. A recent study published in the journal ClinicoEconomics and Outcomes Research, sponsored by ALCOR Scientific, suggests that employing both Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP) tests together can lead to substantial savings for hospitals, challenging the notion that these tests are interchangeable.

Study Overview

This comprehensive economic analysis indicates that the combined approach of using both ESR and CRP reduces misdiagnoses and provides net cost savings compared to using only the CRP test. For an academic medical center with 739 beds in the United States, the estimated annual savings could reach an impressive $9.95 million, primarily by decreasing the costs associated with follow-up care linked to diagnostic errors. These inaccuracies are often due to false positive results from the CRP test alone.

Separating Myths from Facts

Critics of the dual testing strategy often argue that ESR and CRP tests are redundant. This new study directly challenges that assumption. As stated by the authors, “The kinetics of CRP and ESR differ significantly.” While CRP levels spike rapidly within hours of acute inflammation and return to normal quickly, ESR takes longer to rise and remains elevated, which is particularly useful for identifying chronic and subacute inflammatory conditions such as polymyalgia rheumatica, giant cell arteritis, lupus, and some malignancies.

These biological differences underscore that both tests offer complementary clinical insights rather than redundant information. When interpreted correctly, the use of both tests heightens diagnostic accuracy, something unattainable by relying on a single test.

Importance of the Research

These findings emerge at a critical juncture for value-based healthcare. Earlier initiatives like “Choosing Wisely” pushed hospitals to limit “unnecessary” laboratory tests, often highlighting the ESR test as an example. This movement occurred when ESR testing was still done manually, before advancements led to automation, and when evidence surrounding its financial impact on healthcare systems was scant.

In today’s automated testing environment, the ESR test is priced at a mere $2.70 in the U.S., cheaper than a cup of coffee. Moreover, fully automated testing does not increase the burden on clinical laboratories, making the addition of ESR to routine testing minimally impactful in terms of costs. The return on investment — through avoiding diagnostic errors and their subsequent costs — is compelling and seemingly outweighs minimal upfront expenses. The cost of laboratory testing typically remains significantly lower than reimbursement rates, enhancing the cost-effectiveness of the ESR test.

As the authors conclude, “Modern ESR analyzers are fast, automated, and affordable.” The former argument that ESR tests overload laboratories is no longer valid, particularly when evaluating whether the diagnostic value justifies the costs. In the case of a combined strategy using ESR and CRP, the answer is a resounding yes.

Methodology of the Study

The study employed an economic decision tree model that simulated cohorts of 100 patients, evaluated from the perspective of healthcare payers in the United States. Eight conditions were analyzed, including rheumatoid arthritis, inflammatory bowel disease, prosthetic joint infections, giant cell arteritis, pancreatitis, infections, autoimmune disorders, and malignancies. The data for sensitivity and specificity were derived from published clinical literature, with cost sources coming from Medicare and Medicaid reimbursement rates (ESR at $2.70 and CRP at $5.18). The costs for follow-up care stemming from misdiagnoses were extracted from American clinical guidelines and validated by healthcare professionals.

Results held consistent when varying test costs, follow-up care expenses, and input data on diagnostic accuracy.

Conclusion

The study reveals that reducing the use of ESR in the name of cost-saving efforts can backfire. By utilizing ESR and CRP together, the number of diagnostic errors decreases, resulting in lower associated follow-up costs. ESR tests, being quick, automated, and inexpensive, are justified when considering overall healthcare expenditures. While the testing of these two cost-effective inflammatory markers serves to reduce diagnostic errors, one must question continued attempts to dismiss ESR testing entirely. As demonstrated, the true impact of parallel testing for ESR and CRP ultimately hinges on institutional factors, patient population, prevalence of conditions, and more. However, maintaining a clinically valuable test like ESR — which costs payers a mere $2.70 and helps avoid unnecessary follow-ups — remains a rational approach for healthcare systems.

About the Study

Citation: Yarnoff B, Morris W, Zivaripiran H, McCutcheon M, Koshy T. “Economic Evaluation of Combined Testing Strategies Using Erythrocyte Sedimentation Rate and C-Reactive Protein Tests.” ClinicoEconomics and Outcomes Research. 2026;18578961. DOI 10.2147/CEOR.S578961.
Funding: This study was funded by ALCOR Scientific LLC.
Media Contact: Lexa Sullivan, ALCOR Scientific, E-mail [email protected]