title: Utility, charge, and cost of inpatient and emergency department serum folate testing.
abstract: BACKGROUND
  Serum folate levels are commonly ordered for multiple indications in the inpatient and emergency department settings. Since mandatory folic acid fortification in 1998, there has been a decreasing prevalence of folate deficiency in the United States.
  
  
  OBJECTIVE
  Our objective was to determine the indications, rate of deficiency, charge and cost per deficient result, and change in management per deficient result in serum folate testing in inpatients and emergency department patients.
  
  
  METHODS
  Retrospective analysis of all inpatient and emergency department serum folate tests.
  
  
  METHODS
  We analyzed all inpatient and emergency department serum folate tests performed over a 12-month period. We reviewed the charts of 250 patients and all low-normal or deficient serum folate levels to determine indications, comorbidities, and change in management based on result. Charge and cost analyses were performed.
  
  
  METHODS
  All inpatient and emergency department patients with a serum folate test performed at a major medical center in Boston, Massachusetts.
  
  
  RESULTS
  A total of 2093 serum folate tests were performed in 1944 patients with 2 deficient levels. The most common indications were anemia without macrocytosis and anemia with macrocytosis. The amount charged per deficient result was $158,022. The cost to the hospital per deficient result was less than $2093.
  
  
  CONCLUSIONS
  In folic acid fortified countries, serum folate testing has low utility and poor cost effectiveness for all indications in inpatients and emergency department patients.
authors.affiliation: Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA. jtoupal@bidmc.harvard.edu
authors.forename: Jesse
authors.initials: J
authors.lastname: Theisen-Toupal
authors.forename: Gary L
authors.initials: GL
authors.lastname: Horowitz
authors.forename: Anthony C
authors.initials: AC
authors.lastname: Breu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D003362:Cost-Benefit Analysis; D004636:Emergency Service, Hospital / Q000191:economics*; D005260:Female; D005492:Folic Acid / Q000097:blood*; D005494:Folic Acid Deficiency / Q000097:blood / Q000175:diagnosis / Q000191:economics; D006403:Hematologic Tests / Q000191:economics* / Q000706:statistics & numerical data*; D017722:Hospital Charges; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D015415:Biomarkers; D005492:Folic Acid