title: Specialist integrated haematological malignancy diagnostic services: an Activity Based Cost (ABC) analysis of a networked laboratory service model.
abstract: OBJECTIVE
  Specialist Integrated Haematological Malignancy Diagnostic Services (SIHMDS) were introduced as a standard of care within the UK National Health Service to reduce diagnostic error and improve clinical outcomes. Two broad models of service delivery have become established: 'co-located' services operating from a single-site and 'networked' services, with geographically separated laboratories linked by common management and information systems. Detailed systematic cost analysis has never been published on any established SIHMDS model.
  
  
  METHODS
  We used Activity Based Costing (ABC) to construct a cost model for our regional 'networked' SIHMDS covering a two-million population based on activity in 2011.
  
  
  RESULTS
  Overall estimated annual running costs were £1 056 260 per annum (£733 400 excluding consultant costs), with individual running costs for diagnosis, staging, disease monitoring and end of treatment assessment components of £723 138, £55 302, £184 152 and £94 134 per annum, respectively. The cost distribution by department was 28.5% for haematology, 29.5% for histopathology and 42% for genetics laboratories. Costs of the diagnostic pathways varied considerably; pathways for myelodysplastic syndromes and lymphoma were the most expensive and the pathways for essential thrombocythaemia and polycythaemia vera being the least.
  
  
  CONCLUSIONS
  ABC analysis enables estimation of running costs of a SIHMDS model comprised of 'networked' laboratories. Similar cost analyses for other SIHMDS models covering varying populations are warranted to optimise quality and cost-effectiveness in delivery of modern haemato-oncology diagnostic services in the UK as well as internationally.
authors: Departments of Haematology and Histopathology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
authors: C
authors: C
authors: Dalley
authors: School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.
authors: H
authors: H
authors: Basarir
authors: Departments of Haematology and Histopathology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
authors: J G
authors: JG
authors: Wright
authors: Departments of Haematology and Histopathology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
authors: M
authors: M
authors: Fernando
authors: Departments of Haematology and Histopathology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
authors: D
authors: D
authors: Pearson
authors: School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.
authors: S E
authors: SE
authors: Ward
authors: School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.
authors: P
authors: P
authors: Thokula
authors: School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.
authors: A
authors: A
authors: Krishnankutty
authors: Sheffield Diagnostic Genetics Service, Sheffield Children's NHS Foundation Trust, Sheffield, UK.
authors: G
authors: G
authors: Wilson
authors: Sheffield Diagnostic Genetics Service, Sheffield Children's NHS Foundation Trust, Sheffield, UK.
authors: A
authors: A
authors: Dalton
authors: Sheffield Diagnostic Genetics Service, Sheffield Children's NHS Foundation Trust, Sheffield, UK.
authors: P
authors: P
authors: Talley
authors: Departments of Haematology and Histopathology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
authors: D
authors: D
authors: Barnett
authors: Departments of Haematology and Histopathology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
authors: D
authors: D
authors: Hughes
authors: Departments of Haematology and Histopathology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
authors: N R
authors: NR
authors: Porter
authors: Departments of Haematology and Histopathology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
authors: J T
authors: JT
authors: Reilly
authors: Departments of Haematology and Histopathology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
authors: J A
authors: JA
authors: Snowden
mesh_terms: D019411:Clinical Laboratory Techniques; D003362:Cost-Benefit Analysis; D019091:Critical Pathways; D019033:Delivery of Health Care, Integrated / Q000191:economics / Q000458:organization & administration; D017048:Health Care Costs; D019337:Hematologic Neoplasms / Q000175:diagnosis* / Q000191:economics / Q000628:therapy; D006405:Hematology / Q000191:economics / Q000458:organization & administration; D006801:Humans; D007753:Laboratories / Q000191:economics / Q000458:organization & administration; D008495:Medical Oncology / Q000191:economics / Q000458:organization & administration; D018803:Models, Economic; D017146:Models, Organizational; D011237:Predictive Value of Tests; D011379:Prognosis; D015397:Program Evaluation; D012040:Regional Health Planning; D013222:State Medicine; D006113:United Kingdom; D057188:Workflow
keywords: COSTING & PRICING; DIAGNOSTICS; HEMATOPATHOLOGY