Laboratory costs in the context of disease

Background: To determine the contribution of laboratory costs to the overal l costs of managing hospital patients with different diseases, we studied t he costs of laboratory testing overall and in relation to the other costs i ncurred during hospitalization. Methods: We used a database developed by the University HealthSystems Conso rtium containing >1 million patients in 60 University Hospitals with diseas es included in 486 diagnosis-related groups (DRGs). Laboratory costs includ ed in the database comprised those associated with testing in the clinical laboratory together with those incurred in point-of-care testing and anatom ic pathology but not those involving blood products and their transfusion. Results: The mean laboratory costs to manage surgical patients were greater than those to manage medical patients in 19 of the 25 major diagnostic cat egories. The median laboratory costs for patients with liver transplants ex ceeded $8000, and the laboratory costs to support other organ transplants w ere among the highest. The highest proportion of total costs attributable t o the laboratory was 18.3% for acute leukemia and kidney and urinary tract signs and symptoms, both in children. Laboratory costs were <1.0% of the to tal costs for only 15 DRGs. The highest median daily laboratory cost, $416, was attributable to liver transplant patients. Several conditions had medi an laboratory costs less than $30 per day, in spite of lengths of stay that exceeded 10 days in some cases. Conclusions: Although laboratory costs generally average 6% of the total co sts for surgical conditions and 9% of the total costs for medical condition s, there is considerable variability. In general, laboratory costs were rel atively poorly correlated with total costs. However, observation of high da ily laboratory costs for many DRGs suggests that reducing length of stay wo uld reduce both laboratory and total costs. (C) 2000 American Association f or Clinical Chemistry.