A low-cost initiative to reduce duplicate hepatitis B virus serological testing

BACKGROUND: Currently, multiple clinical laboratories provide serological testing for hepatitis B virus (HBV) in Alberta, Canada. Concerns were raised regarding single serology specimens having duplicate testing performed during the specimen referral process from one laboratory to another. In an attempt to reduce duplicate testing for anti-HBs and HBsAg markers, we implemented a stamp on paper requisitions to identify if testing had already been performed on referred specimens. We aimed to determine the number of duplicate tests and cost of duplicate testing pre- and post-stamp implementation. STUDY DESIGN: The requisition stamp was implemented between May and August 2016. HBV serology testing results from two clinical laboratories between January 01, 2015 and December 31, 2017 (n ​= ​803,637) were examined. The number of tests performed on the same individual within a 3-day window was identified and the associated costs were determined. RESULTS: After stamp implementation, duplicated HBsAg and anti-HBs tests decreased from 20.8% (n ​= ​28,545) and 18.4% (n ​= ​20,151) to 3.7% (n ​= ​4,604) and 2.5% (n ​= ​2,593), respectively. This represented an estimated annual savings of $86,427 and $82,522 CAD in supply costs for HBsAg and anti-HBs tests, respectively. CONCLUSIONS: The requisition stamp initiative was effective in reducing the number of duplicate tests performed between two laboratory sites. This low-cost intervention could be applied to other testing situations, including other highly duplicated serological markers, which may have broad reaching cost-saving effects for laboratory testing.