BEYOND THE REAGENT COST: BUDGET IMPACT OF REDUCING LOW-VALUE BASIC COAGULATION TESTING IN AMBULATORY CARE
Author(s)
Manuel R. Lopez, MD1, Elsa Lopez Ansoar, MD2, Paula Sar Fuentes, MD2, Carmen Albo Lopez, PhD, MD2.
1Hematology and Hemotherapy, Hospital Universitario Alvaro Cunqueiro, EOXI Vigo, Vigo, Spain, 2Hospital Universitario Alvaro Cunqueiro, EOXI VIGO, Vigo, Spain.
1Hematology and Hemotherapy, Hospital Universitario Alvaro Cunqueiro, EOXI Vigo, Vigo, Spain, 2Hospital Universitario Alvaro Cunqueiro, EOXI VIGO, Vigo, Spain.
OBJECTIVES: Basic coagulation tests (prothrombin time [PT/INR] and activated partial thromboplastin time [aPTT]) are among the most frequently ordered analyses from primary care, despite low diagnostic yield as screening in asymptomatic patients. We quantified the volume and direct reagent cost of ambulatory basic coagulation testing in a Spanish health area and estimated the budget impact of a demand-management (laboratory stewardship) strategy.
METHODS: Retrospective analysis of laboratory information-system activity for 2025. Non-urgent (ambulatory) basic coagulation studies were identified. Unit reagent costs were derived from current tendered prices (PT €0.2133; aPTT €0.2239; basic study = PT+aPTT = €0.4372). A cost-minimization approach estimated annual reagent expenditure, and a scenario-based budget-impact model estimated savings under 50%, 60% and 70% reductions in inappropriate requests. The reagent cost of a representative downstream cascade triggered by a falsely prolonged aPTT was calculated from the same tendered prices to illustrate indirect costs.
RESULTS: 124,374 non-urgent basic coagulation studies were performed in 2025, representing €54,376/year in reagents alone. Modeled reductions of 50%, 60% and 70% yielded minimum reagent savings of €27,188, €32,626 and €38,063/year, respectively. A single false-positive prolonged-aPTT work-up (repeat testing, mixing study, lupus anticoagulant screening/confirmation, intrinsic factor assays) consumed ≈€10.27 in reagents — roughly 23 times the initial screen — indicating that avoided diagnostic cascades, not the screening reagent, drive the true economic impact. Reagent figures exclude consumables, quality control, equipment, validation and staff, and therefore represent a guaranteed minimum.
CONCLUSIONS: Ambulatory basic coagulation testing is a high-volume, low-value activity amenable to demand management, principally by removing PT/aPTT from default electronic order profiles. Even on a conservative reagent-only basis, savings are meaningful; true system savings are likely several-fold higher once avoided cascades, referrals and loaded process costs are included. Limitations include reagent-only costing, hypothetical reduction scenarios, and a denominator that also captures hospital outpatients.
METHODS: Retrospective analysis of laboratory information-system activity for 2025. Non-urgent (ambulatory) basic coagulation studies were identified. Unit reagent costs were derived from current tendered prices (PT €0.2133; aPTT €0.2239; basic study = PT+aPTT = €0.4372). A cost-minimization approach estimated annual reagent expenditure, and a scenario-based budget-impact model estimated savings under 50%, 60% and 70% reductions in inappropriate requests. The reagent cost of a representative downstream cascade triggered by a falsely prolonged aPTT was calculated from the same tendered prices to illustrate indirect costs.
RESULTS: 124,374 non-urgent basic coagulation studies were performed in 2025, representing €54,376/year in reagents alone. Modeled reductions of 50%, 60% and 70% yielded minimum reagent savings of €27,188, €32,626 and €38,063/year, respectively. A single false-positive prolonged-aPTT work-up (repeat testing, mixing study, lupus anticoagulant screening/confirmation, intrinsic factor assays) consumed ≈€10.27 in reagents — roughly 23 times the initial screen — indicating that avoided diagnostic cascades, not the screening reagent, drive the true economic impact. Reagent figures exclude consumables, quality control, equipment, validation and staff, and therefore represent a guaranteed minimum.
CONCLUSIONS: Ambulatory basic coagulation testing is a high-volume, low-value activity amenable to demand management, principally by removing PT/aPTT from default electronic order profiles. Even on a conservative reagent-only basis, savings are meaningful; true system savings are likely several-fold higher once avoided cascades, referrals and loaded process costs are included. Limitations include reagent-only costing, hypothetical reduction scenarios, and a denominator that also captures hospital outpatients.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE299
Topic
Economic Evaluation, Study Approaches
Topic Subcategory
Budget Impact Analysis
Disease
No Additional Disease & Conditions/Specialized Treatment Areas