GeneTests currently lists 593 laboratories testing for 2,305 diseases – 2,040 clinically based and 265 research based. Check out their chart of lab and test growth over the years 1993-2009.
With this exponential growth of labs and tests with various panels offering different sensitivities for different conditions, how does one choose a lab and how does one choose certain panels over others? In my primarily prenatal role in an academic university hospital, genetic testing is very accessible to my patients as there is patient interest, insurance coverage, and private monies to really make it happen. So, access is no longer the primary issue I deal with and the patients look to me as their genetic counselor to determine which lab offers “the best” test that is most up-to-date. How quickly do we modify what we offer? How does your center choose and vet which labs to use?
Labs are always sending out notices of new panels, sending representatives to educate us about their tests. But, how quickly do you start offering a new panel once you have been educated about it?
Here are some things I think seem to dictate how I choose a lab, in no particular order:
1. What is the sensitivity and specificity of the test?
2. Does the lab provide pre-verification of insurance benefits?
3. Is the customer service accessible and available to strategize regarding the testing plan i.e. are there genetic counselors and laboratory directors that I can speak with?
4. Does this lab have a great deal of experience working with this gene or disease?
5. How quickly do they report their results? Will they expedite prenatal cases?
6. Is the format of their reports accessible?
7. Do they have educational materials about their tests for providers? For patients?
8. Are there logistical shipping issues/costs?
9. For NYS, do I need a permit?
All these things weigh differently in every case, depending on the needs of the patient. But, patients do not always know what is out there or what they need – it can become our job to make the best laboratory choices to fit their needs. Sometimes, this is a challenge for me. And sometimes, I feel like a laboratory sales representative.
It seems to me that if we do not offer a test, it essentially does not exist to a patient. Sometimes patients do not know they want a test out there simply because they do not know about it.
So, when a new panel of tests comes out, how does your center decide what to offer the patients? Is there a departmental debate? Does it have to meet certain internal requirements?
When faced with a handful of lab options sequencing the same gene, how do you chose the lab?
Please share you thoughts and strategies regarding this. I am truly very curious.