#OA1-AM25-ST-21 - Cost Comparison of In-House Antigen Typing vs Ordering from a Blood Supplier and Analysis of Routine Antigen Screening for C, c, E, and K

Identifying antigen-negative RBC units for patients with antibodies from the in-house inventory can be time consuming and costly if ordered from a blood supplier. Maintaining an inventory of antigen-negative RBCs can help alleviate these issues. The team sought to determine cost and tech-time of typing RBCs for C, c, E, and K in-house by automation and manual methods to compare with the cost of ordering from the supplier. The team compared long-term costs of their weekly automated screening of 12 O Pos RBCs for C, c, E, and K to the lab’s prior practice of typing manually and ordering antigen-negative RBCs as needed to see which method provides the most savings.

Study

Design/Methods:

Tech-time to antigen type and reagent usage were determined by direct observation. Reagent costs were gathered from the manufacturer’s website, while the supplier contract listed antigen-typed RBC pricing. To estimate the usage of C, c, E, and/or K negative RBCs over 6 months, a digital report was generated to list all Rh-Pos patients with antibodies to these antigens encountered in the past 6 months. Total RBCs needed for each patient were estimated based on patient location and product usage. Antigen frequencies observed in the lab’s weekly automated screening were used to estimate the antigen-negative RBCs of each type that would have been obtained by screening weekly for 6 months. Cost and tech-time required to perform this screening were also estimated. Cost and tech-time to manually type RBCs as needed for the same patients were calculated by estimating the number of units to test to acquire the total units needed based on published antigen frequencies. It was assumed that all RBCs would be obtained by manual typing except for c negative, E negative RBCs, which would be ordered.

Results/Findings:

Typing for a single antigen-negative RBC saves up to $80.64 using automation and $79.46 by typing manually compared to ordering from the supplier. Testing 12 RBCs for C, c, E, and K costs $43.53 and takes 1 hour of tech-time, compared to $45.36 and 1.5 hours manually. Screening 12 O Pos RBCs a week for 6 months would provide a surplus of every type needed in 6 months while costing $1,131.90 and taking 26 hours of tech-time. Typing and ordering products as needed would have cost $1,884.84 and taken 6 hours.

Conclusions:

Typing RBCs in-house provides significant savings over ordering. Automation saves a large amount of tech-time vs manual typing in large batches. The model shows routine antigen screening is less costly than manual typing and ordering as needed. Routine screening uses more tech-time, but the RBCs are readily available for use. Manual typing or ordering as needed delays the availability of RBCs, especially when waiting for products to be delivered from the supplier.