Optimizing cost-effectiveness in the work-up of orbital inflammation: a multicenter, retrospective study

Purpose To evaluate diagnostic tests and patient characteristics associated with specific diagnoses of orbital inflammation to optimize cost-effectiveness.Methods A retrospective, observational case series, including 121 adult patients who underwent work-up for a clinically inflamed orbit. Chart review collected demographic and clinical information. Cost of testing was estimated based on publicly available data. Logistic regression was used to identify factors associated with a specific diagnosis.Results The median patient age was 49 years, and a majority were female (63%) and White (51%). A mean of five laboratory tests was ordered per patient. Two-thirds of the expenditure on diagnostic testing did not provide key diagnostic information. A specific diagnosis was reached for 31% of patients. Specific final diagnosis was significantly associated (p < 0.05) with older age (OR 1.6 per decade), male gender (OR 2.9), bilateral disease (OR 4.8), diffuse inflammation (OR 11.6), and bone involvement (OR 20.9).Conclusions Orbital inflammation was associated with a broad diagnostic work-up that led to a nonspecific diagnosis in the majority of cases. Cost savings may be achieved by judicious use of tests that provide limited diagnostic information (ANA, anti-dsDNA, ACE, anti-CCP, ESR, CRP, platelets) and reserving comprehensive work-up for patients with risk factors.