Economic Impact of Clinical Laboratory

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Alinejhad, M., Aghlmand, S., Feizollahzadeh, S., & Yusefzadeh, H. (2020). The economic efficiency of clinical laboratories in public hospitals: A case study in Iran. Journal of Clinical Laboratory Analysis, 34(2), e23067.

Clinical laboratories are some of the most expensive units of the healthcare system; therefore, it is essential to assure their cost-efficiency. The purpose of this study was to assess the cost-effectiveness of laboratory units affiliated with a number of hospitals to evaluate their performance. Alinejhad et al. (2020) concluded that the majority of units were not economically efficient and that optimal allocation of resources needed to be considered.

Apostu, S. A., Vasile, V., & Veres, C. (2021). Externalities of lean implementation in medical laboratories. Process optimization vs. adaptation and flexibility for the future. International Journal of Environmental Research and Public Health, 18(23), 12309.

The purpose of this paper was to identify the challenges faced by specialists in the field of optimization of medical services by introducing a number of variants of the Lean Six Sigma method. The results showed that the Lean Six Sigma method helps to reduce the incidence of diagnostic errors and saves time, but also might be the cause of problems and resistance from employees in the implementation.

Arshoff, L., Hoag, G., Ivany, C., & Kinniburgh, D. (2021). Laboratory medicine: The exemplar for value-based healthcare. Healthcare Management Forum, 34(3), 175-180.

Value-Based Healthcare (VBHC) aims at improving healthcare’s overall quality and safety while reducing the cost of delivering more effective treatment. Laboratory Medicine (LM) is perfect for leading the transition to VBHC due to its key role in diagnosing and treating patients. This article summarizes issues related to the introduction of VBHC and suggests approaches to help accelerate its implementation using LM-specific examples.

Crawford, J. M., Shotorbani, K., Sharma, G., Crossey, M., Kothari, T., Lorey, T. S., Prichard J.W., Wilkerson, M., & Fisher, N. (2017). Improving American healthcare through “Clinical Lab 2.0”: A Project Santa Fe report. Academic Pathology, 4, 1-8.

Project Santa Fe was created to help develop the evidence base for valuating American clinical laboratory services. This paper sums up the key points of Project’s meeting in March, 2016. In the transition to value-based health care, clinical laboratories are to provide policy guidance in reducing overall treatment costs by optimizing time-to-diagnosis therapeutics, care coordination, and support for screening and monitoring.

Davies, J., Abimiku, A., Alobo, M., Mullan, Z., Nugent, R., Schneidman, M., Sikhondze, W., & Onyebujoh, P. (2017). Sustainable clinical laboratory capacity for health in Africa. The Lancet Global Health, 5(3), e248-e249.

At the meeting of the African Society for Laboratory Medicine in Cape Town, Davies et al. (2017) met to discuss the state of laboratory services in Africa considering its burden of both communicable and non-communicable diseases. They emphasized gaps in quality, coverage, access, infrastructure, human resources, and sustainability, and discussed how these could be addressed in an economically viable manner.

Ellison, T. L., Alharbi, M., Alkaf, M., Elimam, S., Alfaries, M., Al Nounou, R., Nasr, R., & Owaidah, T. (2018). Implementation of total laboratory automation at a tertiary care hospital in Saudi Arabia: Effect on turnaround time and cost efficiency. Annals of Saudi Medicine, 38(5), 352-357.

Total Laboratory Automation (TLA) is an innovative way to improve the management of high-volume clinical laboratories. TLA contributes to reducing staff and operating costs, decreasing testing time, and providing advanced process control. Ellison et al. (2018) concluded that a thorough review of the set of assays should be undertaken to maximize efficiency and ensure that the system meets the requirements.

Kim, K., Lee, S. G., Kim, T. H., & Lee, S. G. (2022). Economic evaluation of total laboratory automation in the clinical laboratory of a tertiary care hospital. Annals of Laboratory Medicine, 42(1), 89-95.

TLA, being innovative for laboratory technology, cannot, however, be widely adopted due to its high up-front costs. In order to assess the appropriateness of investing in TLA, Kim et al. (2022) analyzed its clinical and economic efficiency for the expected payback period. As a result, it was considered that the investment in the adoption of TLA is justified.

Lippi, G., & Da Rin, G. (2019). Advantages and limitations of total laboratory automation: A personal overview. Clinical Chemistry and Laboratory Medicine, 57(6), 802-811.

When it comes to TLA, on the one hand, it improves efficiency and standardization, as well as safety and quality of laboratory testing. On the other hand, some potential problems include higher initial costs, infrastructure constraints and space requirements, and increased risks of downtime. In this study, Lippi and Da Rin (2019) provide their personal overview of some of the technology’s benefits and drawbacks.

Meier, F. A., Badrick, T. C., & Sikaris, K. A. (2018). What’s to be done about laboratory quality? Process indicators, laboratory stewardship, the outcomes problem, risk assessment, and economic value: Responding to contemporary global challenges. American Journal of Clinical Pathology, 149(3), 186-196.

Indicators of healthcare quality are generally considered to be structure, process, and results. When it comes to clinical laboratories, for process assessment, quality indicators – statistical monitors of steps in the total clinical laboratory testing – have been widely disseminated worldwide. To overview what further development might look like, Meier et al. (2018) have conducted a review of publications on quality assessment of clinical laboratories.

Mouseli, A., Barouni, M., Amiresmaili, M., Samiee, S. M., & Vali, L. (2017). Cost-price estimation of clinical laboratory services based on activity-based costing: A case study from a developing country. Electronic Physician, 9(4), 4077-4083.

Laboratory tariffs in Iran are believed to not reflect the real costs, which might expose private laboratories to financial difficulties. This study was aimed at determining the real cost of the various clinical tests of a private clinical laboratory. Mouseli et al. (2017) concluded that a way to address this problem was to increase the number of laboratory tests in terms of laboratory capacity.

Pennestrì, F., & Banfi, G. (2019). Value-based healthcare: The role of laboratory medicine. Clinical Chemistry and Laboratory Medicine, 57(6), 798-801.

The global growth in demand for health services is forcing policymakers to provide quality healthcare at sustainable cost. Among the most promising approaches that have been developed for this problem’s addressing is VBHC. Pennestrì and Banfi (2019) concluded that introduction of laboratory medicine specialists to VBHC would be useful in enhancing skills in data structure, quality control, and cost assessment.

Petersen, L. M., Martin, I. W., Moschetti, W. E., Kershaw, C. M., & Tsongalis, G. J. (2019). Third-generation sequencing in the clinical laboratory: Exploring the advantages and challenges of nanopore sequencing. Journal of Clinical Microbiology, 58(1), e01315-19.

Metagenomic sequencing for the diagnosis of infectious diseases is an excellent tool that is promising in terms of use in a clinical laboratory. Implementation challenges include high costs, long lead times to results, and the need for knowledge of technicals and bioinformatics. However, as Petersen et al. (2019) discovered, technological innovations in nanopore sequencing have the potential to address these problems.

Plebani, M. (2018). Clinical laboratory: Bigger is not always better. Diagnosis, 5(2), 41-46.

Laboratory services are currently undergoing significant consolidation and changes through various mechanisms. However, the ratio between volume and costs is not linear, and many variables influence the final cost of each test. Plebani (2018) emphasizes the need for a paradigm shift: from a focus on efficacy and volumes to a patient-centered vision.

Rodriguez-Borja, E., Corchon-Peyrallo, A., Diaz-Gimenez, M., & Carratala-Calvo, A. (2018). Computer physician order entry (CPOE) as a strategy to estimate laboratory activity and costs associated with cancer clinical trials. Biochemia Medica, 28(3), 439-445.

Most clinical laboratories are not adequately compensated for the clinical trial activities in their facilities due to a lack of measurement strategies. Rodriguez-Borja et al. (2018) have introduced a specific computer physician order entry environment for clinical trials to assess the associated costs, which were to be compared to the standard of care. Such strategies proved to be a promising tool able to improve laboratory associated costs estimation.

Ross, J., Penesis, J., & Badrick, T. (2019). Improving laboratory economic and environmental performance by the implementation of an environmental management system. Accreditation and Quality Assurance, 24(5), 319-327.

The RCPAQAP – a medium-sized healthcare organization – has started to integrate environmental management systems (EMS) into its business practices. Among the real benefits there were improved environmental consequences and financial performance, as well as savings in waste, power, and paper. This paper is the documentation of the process that has led to the successful implementation of an EMS into the organization’s business practices.

Sabev, N., & Trancheva, D. (2018). Organizational and economic aspects of clinical and laboratory activities-possibilities and perspectives of optimization. Knowledge – International Journal, 26(6), 1721-1726.

Laboratory units are thought to determine the status of a national healthcare system. The efficiency of the laboratory diagnostic processes can be secured by two main elements – high-tech equipment and professional staff. According to Sabev and Trancheva (2018), there is a need to identify and use internal reserves to optimize the scope of work and structure of laboratory and diagnostic units.

Santos, P. R., Silva, C. L., Gall, M. C., & Grando, A. C. (2021). Impact of pre-analytical errors on costs of clinical analysis laboratory. Jornal Brasileiro de Patologia e Medicina Laboratorial, 57, 1-5.

It is well-known that quality assurance systems in healthcare organizations are being constantly improved. Quality enhancement can reduce costs by avoiding exam repetitions, which result in a loss of a company’s time and money and customer and physician dissatisfaction. In this study, Santos et al. (2021) aimed at quantifying the costs of pre-analysis errors for the laboratory using data collection indicators, direct material costs and maintenance costs.

Thomson, R. B., & McElvania, E. (2019). Total laboratory automation: What is gained, what is lost, and who can afford it? Clinics in Laboratory Medicine, 39(3), 371-389.

America’s first clinical microbiological laboratory adopted full automation for bacteriological treatment in 2014. Since then, other organizations have followed with the installation of two systems: either BD Kiestra TLA or Copan WASPLab. This paper discusses American automated systems that are commercially available; why automation is needed in general; and how it improves the quality and efficiency and saves costs.

Trancheva, D. (2018). Management and economic efficiency of clinical laboratory activities. Knowledge – International Journal, 28(2), 699-703.

The notion of a ‘clinical laboratory’ is of increasing importance and value in medicine. Clinical laboratories are generally considered financially expensive units because those situated in larger organizational units have difficulty obtaining accurate financial data. Trancheva (2018) states that writing a laboratory budget – that is, a laboratory’s comprehensive financial plan – is a reliable tool for facilitating effective financial management.

Vázquez, M., Anfossi, L., Ben-Yoav, H., Diéguez, L., Karopka, T., Della Ventura, B., Abalde-Cela, S., Minopoli, A., Di Nardo, F., Shukla, V. K., Teixeira, A., Tvarijonaviciute, A., & Franco-Martínez, L. (2021). Use of cost-effective technologies for a routine clinical pathology laboratory. Lab on a Chip, 21(22), 4330-4351.

A major constraint on the capacity of clinical pathology laboratories, particularly in developing countries, is the need for expensive, highly sophisticated instruments. To make clinical pathology more accessible, many free or cost-effective technologies have been developed recently. This article provides an overview of current cost-effective alternatives used in conventional clinical pathological laboratories.

References

Alinejhad, M., Aghlmand, S., Feizollahzadeh, S., & Yusefzadeh, H. (2020). The economic efficiency of clinical laboratories in public hospitals: A case study in Iran.Journal of Clinical Laboratory Analysis, 34(2), e23067.

Apostu, S. A., Vasile, V., & Veres, C. (2021). Externalities of lean implementation in medical laboratories. Process optimization vs. adaptation and flexibility for the future.International Journal of Environmental Research and Public Health, 18(23), 12309.

Arshoff, L., Hoag, G., Ivany, C., & Kinniburgh, D. (2021). Laboratory medicine: The exemplar for value-based healthcare.Healthcare Management Forum, 34(3), 175-180.

Lippi, G., & Da Rin, G. (2019). Advantages and limitations of total laboratory automation: A personal overview. Clinical Chemistry and Laboratory Medicine, 57(6), 802-811.

Pennestrì, F., & Banfi, G. (2019). Value-based healthcare: The role of laboratory medicine.Clinical Chemistry and Laboratory Medicine, 57(6), 798-801.

Petersen, L. M., Martin, I. W., Moschetti, W. E., Kershaw, C. M., & Tsongalis, G. J. (2019). Third-generation sequencing in the clinical laboratory: Exploring the advantages and challenges of nanopore sequencing.Journal of Clinical Microbiology, 58(1), e01315-19.

Plebani, M. (2018). Clinical laboratory: Bigger is not always better. Diagnosis, 5(2), 41-46.

Ross, J., Penesis, J., & Badrick, T. (2019). Improving laboratory economic and environmental performance by the implementation of an environmental management system.Accreditation and Quality Assurance, 24(5), 319-327.

Sabev, N., & Trancheva, D. (2018). Organizational and economic aspects of clinical and laboratory activities-possibilities and perspectives of optimization.Knowledge – International Journal, 26(6), 1721-1726.

Santos, P. R., Silva, C. L., Gall, M. C., & Grando, A. C. (2021). Impact of pre-analytical errors on costs of clinical analysis laboratory.Jornal Brasileiro de Patologia e Medicina Laboratorial, 57, 1-5.

Thomson, R. B., & McElvania, E. (2019). Total laboratory automation: What is gained, what is lost, and who can afford it?Clinics in Laboratory Medicine, 39(3), 371-389.

Trancheva, D. (2018). Management and economic efficiency of clinical laboratory activities. Knowledge – International Journal, 28(2), 699-703.

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Economic Impact of Clinical Laboratory

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