title: The HI-STAR study: resource utilization and costs associated with serologic testing for antibody-positive patients at four United States medical centers.
abstract: BACKGROUND
  Little is known about how the resource utilization and costs of serologic work ups for positive antibody screens vary across subpopulations based on diagnosis, transfusion history, and serologic testing history.
  
  
  METHODS
  Detailed data were collected on patient demographics, diagnoses, transfusion history, history of known allo- and autoantibodies, and specific serologic tests performed for 6077 consecutive serologic work ups in 3608 antibody-positive patients between 2009 and 2011 at four US academic medical centers. Direct testing costs were also determined at each site for each serologic test performed to calculate total costs per work up and per patient over the duration of the study.
  
  
  RESULTS
  The mean direct cost of serologic testing was $114 per work up and $195 per patient. The mean cost per patient was significantly higher for 12 of 19 diagnostic categories evaluated, including autoimmune hemolytic anemia (mean cost per patient, $1490; p < 0.001), hematologic malignancies ($640, p < 0.001), and transplant recipients ($462, p = 0.019). Patient transfusion and serologic testing characteristics associated with greatest increases in costs included history of a warm autoantibody ($626, p < 0.001) and more than five prior transfusions ($404, p < 0.001).
  
  
  CONCLUSIONS
  Antibody-positive patients with complex diagnoses or transfusion histories require significantly more resources and incur greater cost to assess red blood cell antibody status.
authors.affiliation: Mazonson and Santas LLC, Larkspur, California; University of California Los Angeles Medical Center, Los Angeles, California; University of Texas Southwestern Medical Center, Dallas, Texas; Virginia Commonwealth University Medical Center, Richmond, Virginia; Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Peter
authors.initials: P
authors.lastname: Mazonson
authors.forename: Molly
authors.initials: M
authors.lastname: Efrusy
authors.forename: Chris
authors.initials: C
authors.lastname: Santas
authors.forename: Alyssa
authors.initials: A
authors.lastname: Ziman
authors.forename: James
authors.initials: J
authors.lastname: Burner
authors.forename: Susan
authors.initials: S
authors.lastname: Roseff
authors.forename: Arthi
authors.initials: A
authors.lastname: Vijayaraghavan
authors.forename: Richard
authors.initials: R
authors.lastname: Kaufman
mesh_terms: D000046:Academic Medical Centers / Q000191:economics; D000328:Adult; D000744:Anemia, Hemolytic, Autoimmune / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy; D000906:Antibodies / Q000097:blood*; D001803:Blood Transfusion / Q000191:economics*; D017046:Cost Savings; D005260:Female; D017048:Health Care Costs; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012698:Serologic Tests / Q000191:economics* / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D014600:Utilization Review
chemical_list: D000906:Antibodies