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Utilization and Cost Effectiveness of Standardized Testing for Screening and Confirmation of Drugs of Abuse in Urine

Address correspondence to Gifford Lum, M.D., Laboratory Medicine Service, VA Boston Healthcare System, 1400 VFW Parkway, Boston, MA 02132, USA; tel 617 323 7700, x5992; fax 617 363 5623; e-mail gifford.lum{at}med.va.gov.

Screening and confirmation testing for drugs of abuse in urine (DAU) represent areas for potential reduction of laboratory workload and attendant cost savings. Following a careful review of the clinical needs of the underlying veteran patient population served by 7 medical facilities in the Boston area, DAU test ordering frequencies, positive rates for several screening panels and the associated confirmation tests, DAU panel standardization, and confirmation testing only by request were introduced. These changes were all reviewed and approved by the clinician users of DAU testing at each institution before the changes were implemented. Before standardization of DAU screening panels, 59,835 DAU screening requests were done at a cost of $216,005; following standardization, there was 47% decrease in DAU screening utilization (27,876) and costs ($100,633). Before implementation of a DAU confirmation by request only policy, 5,331 confirmation tests were done at a cost of $111,502; after institution of the confirmation policy, there was 95% decrease in confirmation tests (5,080) and costs ($105,826). DAU panel standardization and DAU confirmation by request only have resulted in substantial reductions of laboratory workload and costs in a veterans population and may serve as a model for other patient populations with perhaps similar outcomes.

Keywords: drugs of abuse in urine, assay standardization, confirmation, utilization, cost analysis

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