The Cost of High Quality
All laboratories seek to provide an accurate result to support the physician’s role in treating patients effectively. LC-MS/MS is an excellent option to deliver high quality; however, the issue is complexity.
The current generation of LC-MS/MS solutions requires highly trained operators, forcing most clinical laboratories to use traditional methods such as immunoassays. Another option includes sending out tests to reference laboratories that are equipped with LC-MS/MS technology; however, there are trade-offs with this practice. Send-out testing is expensive and it requires the clinician to wait longer for a test result. This alternative is becoming less viable due to the growing number of people gaining access to healthcare and a general increase in testing volumes. Notable examples include the global testing market for vitamin D tests, which is expected to grow at a compound annual growth rate of 33.5 percent through 2014.1 Also, the rise in use and abuse of opiate/opioid drugs for pain management is also putting pressure on clinical laboratories to provide high-quality services in this area.2
“We’re spending $500,000 a year on tests we send out to reference labs,” says Amin Mohammad, Ph.D., a pathology professor at the Texas A&M University System Health Science Center and Medical Director of Laboratory Information System at the affiliated Scott & White Health Care System. “This burden has grown quickly over the past few years because of the intensified focus on better pain management and the parallel problem of drug abuse. Having LC-MS/MS in our laboratory could reduce our costs dramatically and also reduce the very real possibility of sample loss or mix-up. We would recoup our investment in one and a half years while improving patient care.”
Cost concerns are putting pressure on clinics in Europe as well. “We’re expected to do more with less,” says Pierre Marquet, head of the department of pharmacology-toxicology, University Hospital of Limoges, France. Like other parts of the world, France has weathered a recent recession that saw taxes rise and government workforces shrink. “We try to integrate and automate as much as possible the different aspects of our lab workflow. A more automated, integrated LC-MS/MS system would offer possibilities of 24/7 LC-MS/MS testing by all our technicians or fellows with basic lab tech skills and more affordable salaries.”
Josh Bornhorst, director of chemistry, immunology, point-of-care, and pediatric clinical laboratories, University of Arkansas states, “Turnaround time is also a major factor for labs, and time is lost when samples go out to reference labs for testing. We now have to send out drugs of abuse confirmations, but we could do them in house with mass spectrometry.” He estimates that LC-MS/MS at the university medical center could reduce turnaround times from two to four days for outsourced tests to a matter of hours for in-house tests. “That would improve patient care,” says Bornhorst.
Adds Mohammad, “By reducing our turnaround time from 10 days to as little as an hour with in-house LC-MS/MS, we would improve our service to physicians, meaning better patient care, whether a patient needs medication or addiction counseling.”