title: Laboratory costs of a hospital-based blood transfusion service in Malawi.
abstract: BACKGROUND
  Despite policies advocating centralised transfusion services based on voluntary donors, the hospital-based replacement donor system is widespread in sub-Saharan Africa.
  
  
  OBJECTIVE
  To evaluate the cost of all laboratory resources needed to provide a unit of safe blood in rural Malawi using the family replacement donor system
  
  
  METHODS
  Full economic costs of all laboratory tests used to screen potential donors and to perform cross-matching were documented in a prospective, observational study in Ntcheu district hospital laboratory.
  
  
  RESULTS
  1729 potential donors were screened and 11,008 tests were performed to ensure that 1104 units of safe blood were available for transfusion. The annual cost of all transfusion-related tests (in 2005 USdollars) was USdollars 17,976, equivalent to USdollars 16.28 per unit of transfusion-ready blood. Transfusion-related tests used 53% of the laboratory's total annual expenditure of USdollars 33,608.
  
  
  CONCLUSIONS
  This is the first study to provide prospective economic costs of all laboratory tests associated with the family replacement donor system in a district hospital in Africa. Results show that despite potential economies of scale, a unit of blood from the centralised system costs about three times as much as one from the hospital-based "replacement" system. Factors affecting these relative costs are complex but are in part due to the cost of donor recruitment in centralised systems. In the replacement system the cost of donor recruitment is entirely borne by families of patients needing a blood transfusion.
authors.affiliation: Liverpool School of Tropical Medicine, Liverpool, UK.
authors.forename: Antonieta Medina
authors.initials: AM
authors.lastname: Lara
authors.forename: James
authors.initials: J
authors.lastname: Kandulu
authors.forename: Laphiod
authors.initials: L
authors.lastname: Chisuwo
authors.forename: Andrew
authors.initials: A
authors.lastname: Kashoti
authors.forename: Catherine
authors.initials: C
authors.lastname: Mundy
authors.forename: Imelda
authors.initials: I
authors.lastname: Bates
mesh_terms: D000328:Adult; D001782:Blood Donors; D001788:Blood Grouping and Crossmatching / Q000191:economics; D001803:Blood Transfusion / Q000191:economics*; D003906:Developing Countries; D005260:Female; D006302:Health Services Research; D006403:Hematologic Tests / Q000191:economics; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006767:Hospitals, District / Q000191:economics; D006801:Humans; D007755:Laboratories, Hospital / Q000191:economics*; D008295:Malawi; D008297:Male; D011446:Prospective Studies; D019035:Rural Health Services / Q000191:economics; D020858:Tissue and Organ Harvesting / Q000191:economics