Cost-Benefit Analysis of the preliminary step prior to classical Lupus Anticoagulant detection assays

Dr. Mansour S Aljabry

Volume : VII, Issue : I, January - 2018

Cost-Benefit Analysis of the preliminary step prior to classical Lupus Anticoagulant detection assays

Dr. Mansour S Aljabry

Abstract :

Background: The classical panel of lupus anti–coagulant (LA) test involves a number of cumbersome and expensive assays. Proper patient selection by introduction of a preliminary step prior to classical panel of LA may be a cost–benefit approach.

Objectives: This study was performed to evaluate the cost benefit of the preliminary step prior to full panel LA test.

Design: This retrospective study was performed in coagulation laboratory from Feuary 2013 to Feuary 2015.

Setting: This study was performed in coagulation laboratory at King Khalid University Hospital.

Patients and Methods: An algorithm for LA test was designed according to the ISTH guidelines. It involved introduction of a preliminary step comprising of INR, thrombin time (TT) and fiinogen assay to be performed on all LA requisitions prior to classical LA test. Any LA test request with high TT (>16 seconds) or high INR (>1.5) or low fiinogen (<1.2 g/l) was considered invalid request and the sample was not subjected to the classical LA assays. LA requests with normal TT, INR and fiinogen levels were considered valid request in which the classical LA panel were performed.

Main Outcome Measures: The following equation was used to obtain the net cost–benefit:

Net cost–benefit =Total earned benefit obtained from the excluded requests – Cost of preliminary step of all requests.

Results: A total of 417 lupus anticoagulant requests were received in coagulation laboratory. 329 (78.9%) were valid requests whereas 88(22.1%) were invalid requests and only the preliminary step were carried out. The net saving generated from adding of the preliminary step to the LA test was 13973.3 USD.

Conclusions: Preliminary step prior to classical LA assays is a substantial cost–benefit approach for proper utilization of laboratory resources. Moreover, it rectifies the improper requisition of highly specialized and costly coagulation tests.

< clear="all" style="mso–special–character:line–eak; page–eak–before:always" />