The revenue generated from clinical chemistry and hematology laboratory services as determined using activity-based costing (ABC) model

Activity-based cost analysis of laboratory tests in clinical chemistry

OJECTIVES

Since health care budgets are limited and must be allocated efficiently, there is an economic pressure to reduce the costs of health care interventions. This study aims to investigate the cost of testing within a Clinical Chemistry laboratory.

METHODS

This study was conducted in the Clinical Chemistry laboratory of the University Hospital UZ Brussel, Belgium, in which 156 tests were included and an average cost per test was calculated for the year 2018. Activity-based costing (ABC) was applied, using a top-down perspective. Costs were first allocated to different activity centers and subsequently to different tests. Number of tests, parameters, analyzers and time estimates were used as activity cost drivers.

RESULTS

The blood glucose test on the point-of-care testing (POCT) analyzer Accu Chek Inform II had the lowest unit cost (€0.92). The determination of methanol, ethanol and isopropanol on the GC-FID (7820A) is the test with the highest unit cost (€129.42). In terms of average cost per test per activity center, core laboratory (€3.37) scored lowest, followed consecutively by POCT (€3.49), diabetes (€22.09), toxicology (€31.52), metabolic disorder (€41.53) and cystic fibrosis (€86.02). The cost per test was mainly determined by staff (57%), costs of support services (23%) and reagents (14%).

CONCLUSIONS

High-volume and automated tests have lower unit costs, as is the case with the core laboratory. ABC provides the ability to identify high average cost tests that can benefit from optimizations, such as focusing on automation or outsourcing low-volume tests that can benefit from economies of scale.

Budgetary Impact of Compliance With STI Screening Guidelines in Persons Living With HIV

INTRODUCTION

The 2015 Centers for Disease Control Sexually Transmitted Diseases Treatment Guidelines recommend annual screening of all people living with HIV (PLWH) for Neisseria gonorrhoeae, Chlamydia trachomatis, and syphilis; annual Trichomonas vaginalis screening is recommended for HIV-infected women. The study objective was to evaluate the budgetary impact of sexually transmitted infection (STI) screening. We hypothesized that recommended STI screening is costly and would not be covered in full by insurers.

METHODS

This cost analysis evaluates charges and reimbursement for recommended screening for the above 4 STIs. This study projects the net yield (reimbursement minus expenditures) of providing tests to eligible PLWH receiving care at an urban HIV clinic in Birmingham, AL. Four scenarios evaluated the net yield when different laboratory providers, rates of compliance, and Ryan White Program fund availability were examined.

RESULTS

The number of patients receiving care at our HIV clinic from August 2014 to August 2015 was 3163 (768 female and 2395 male patients). Annual screening for N. gonorrhoeae, C. trachomatis, syphilis, and T. vaginalis would lead to a mean net loss of $129,416, $118,304, $72,625, and $13,523, respectively. Most costly scenarios for a health system include the use of a regional laboratory (-$1,241,101) and lack of Ryan White HIV/AIDS Program funding (-$85,148).

DISCUSSION

Compliance with STI screening practices is costly. Sustainability will require critical analysis of true costs and cost-effectiveness of STI screening tests in PLWH. Providers, policy makers, and insurers each have a role in ensuring the provision of these evidence-based services to PLWH.